|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$68.82 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$68.82 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$68.82 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SYRINGE [222773]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$598.32 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.32
|
| Rate for Payer: Blue Shield of California Commercial |
$20.92
|
| Rate for Payer: Blue Shield of California Commercial |
$20.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.92
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Senior |
$0.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.09
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.57
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
IP
|
$22.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.52
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.44
|
| Rate for Payer: Heritage Provider Network Senior |
$10.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$16.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.47
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
|
OP
|
$22.55
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$598.32 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.32
|
| Rate for Payer: Blue Shield of California Commercial |
$20.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.92
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.44
|
| Rate for Payer: Heritage Provider Network Senior |
$10.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.79
|
| Rate for Payer: Multiplan Commercial |
$16.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.02
|
| Rate for Payer: TriValley Medical Group Senior |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: Vantage Medical Group Senior |
$19.17
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.51
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$598.32 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.32
|
| Rate for Payer: Blue Shield of California Commercial |
$20.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.92
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$598.32 |
| Rate for Payer: Dignity Health Medi-Cal |
$10.77
|
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.32
|
| Rate for Payer: Blue Shield of California Commercial |
$20.92
|
| Rate for Payer: Blue Shield of California Commercial |
$20.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.92
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Heritage Provider Network Senior |
$5.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Senior |
$4.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.77
|
| Rate for Payer: Vantage Medical Group Senior |
$10.77
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.72
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$45,235.51
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$33,757.84 |
| Max. Negotiated Rate |
$45,235.51 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,757.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,757.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,821.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45,235.51
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$84,703.66
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$63,211.69 |
| Max. Negotiated Rate |
$84,703.66 |
| Rate for Payer: EPIC Health Plan Medicare |
$63,211.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,211.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72,693.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84,703.66
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,784.59
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$25,958.65 |
| Max. Negotiated Rate |
$34,784.59 |
| Rate for Payer: EPIC Health Plan Medicare |
$25,958.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,958.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,852.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,784.59
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$110,887.80
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$82,752.09 |
| Max. Negotiated Rate |
$110,887.80 |
| Rate for Payer: EPIC Health Plan Medicare |
$82,752.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,752.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95,164.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$110,887.80
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
IP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.63 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.01
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.38
|
| Rate for Payer: Heritage Provider Network Senior |
$211.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.14
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.16
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
OP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.63 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$282.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.06
|
| Rate for Payer: Blue Shield of California Commercial |
$175.99
|
| Rate for Payer: Blue Shield of California EPN |
$175.99
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$182.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.38
|
| Rate for Payer: Heritage Provider Network Senior |
$211.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$182.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$217.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$209.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$244.13
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.62
|
| Rate for Payer: TriValley Medical Group Senior |
$182.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Vantage Medical Group Senior |
$200.41
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
IP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.63 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.01
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.38
|
| Rate for Payer: Heritage Provider Network Senior |
$211.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.14
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.16
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
OP
|
$456.54
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.63 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: Adventist Health Commercial |
$91.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$282.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.06
|
| Rate for Payer: Blue Shield of California Commercial |
$175.99
|
| Rate for Payer: Blue Shield of California EPN |
$175.99
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$182.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.38
|
| Rate for Payer: Heritage Provider Network Senior |
$211.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$182.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$217.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$209.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$244.13
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.62
|
| Rate for Payer: TriValley Medical Group Senior |
$182.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.41
|
| Rate for Payer: Vantage Medical Group Senior |
$200.41
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 0378668877
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6808464301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE [26224]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 1366809690
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
|
