|
Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)
|
Facility
OP
|
$13,902.11
|
|
|
Service Code
|
CPT 42145
|
| Min. Negotiated Rate |
$753.28 |
| Max. Negotiated Rate |
$13,902.11 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$753.28
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,902.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,048.59
|
| Rate for Payer: TriValley Medical Group Senior |
$7,316.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
OP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$2,813.44 |
| Rate for Payer: Adventist Health Commercial |
$750.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,577.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.52
|
| Rate for Payer: Blue Shield of California Commercial |
$24.18
|
| Rate for Payer: Blue Shield of California EPN |
$24.18
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,725.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.16
|
| Rate for Payer: Dignity Health Senior |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,736.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,736.83
|
| Rate for Payer: Humana Medicare |
$26.51
|
| Rate for Payer: IEHP Medi-Cal |
$51.51
|
| Rate for Payer: IEHP Medicare Advantage |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$2,813.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.16
|
| Rate for Payer: TriValley Medical Group Senior |
$26.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,367.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,253.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.16
|
| Rate for Payer: Vantage Medical Group Senior |
$26.51
|
|
|
PALIFERMIN 6.25 MG INTRAVENOUS SOLUTION [40400]
|
Facility
IP
|
$3,751.26
|
|
|
Service Code
|
CPT J2425
|
| Hospital Charge Code |
1753463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$678.98 |
| Max. Negotiated Rate |
$2,813.44 |
| Rate for Payer: Adventist Health Commercial |
$750.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,577.12
|
| Rate for Payer: Cash Price |
$1,688.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,725.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,539.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$937.82
|
| Rate for Payer: Multiplan Commercial |
$2,813.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,367.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,253.30
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
IP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$484.82 |
| Max. Negotiated Rate |
$2,008.93 |
| Rate for Payer: Adventist Health Commercial |
$535.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,840.18
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,232.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,446.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,813.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$976.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$894.91
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML INTRAMUSCULAR SYRINGE [99702]
|
Facility
OP
|
$2,678.57
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
NDG99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$2,008.93 |
| Rate for Payer: Adventist Health Commercial |
$535.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,840.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.57
|
| Rate for Payer: Blue Shield of California Commercial |
$13.43
|
| Rate for Payer: Blue Shield of California EPN |
$13.43
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cash Price |
$1,205.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,232.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Senior |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,714.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,240.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.18
|
| Rate for Payer: Humana Medicare |
$14.32
|
| Rate for Payer: IEHP Medi-Cal |
$29.30
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.04
|
| Rate for Payer: Multiplan Commercial |
$2,008.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Senior |
$14.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$976.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$894.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
OP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$2,008.88 |
| Rate for Payer: Adventist Health Commercial |
$535.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,840.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.57
|
| Rate for Payer: Blue Shield of California Commercial |
$13.43
|
| Rate for Payer: Blue Shield of California EPN |
$13.43
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,232.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Senior |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,714.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,240.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.15
|
| Rate for Payer: Humana Medicare |
$14.32
|
| Rate for Payer: IEHP Medi-Cal |
$29.30
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.04
|
| Rate for Payer: Multiplan Commercial |
$2,008.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Senior |
$14.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$976.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$894.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE [108109]
|
Facility
IP
|
$2,678.50
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
1712607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$484.81 |
| Max. Negotiated Rate |
$2,008.88 |
| Rate for Payer: Adventist Health Commercial |
$535.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,840.13
|
| Rate for Payer: Cash Price |
$1,205.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,232.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,446.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,813.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.62
|
| Rate for Payer: Multiplan Commercial |
$2,008.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$976.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$894.89
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
IP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$746.72 |
| Max. Negotiated Rate |
$3,094.12 |
| Rate for Payer: Adventist Health Commercial |
$825.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,834.22
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,897.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,227.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.38
|
| Rate for Payer: Multiplan Commercial |
$3,094.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,504.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,378.33
|
|
|
PALIVIZUMAB 100 MG/ML INTRAMUSCULAR SOLUTION [41675]
|
Facility
OP
|
$4,125.50
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
NDG41675
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$4,516.95 |
| Rate for Payer: Adventist Health Commercial |
$825.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,516.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,834.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$373.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,261.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,727.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,727.47
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cash Price |
$1,856.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,897.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.65
|
| Rate for Payer: Dignity Health Senior |
$373.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,640.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$339.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,910.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,910.11
|
| Rate for Payer: Humana Medicare |
$339.68
|
| Rate for Payer: IEHP Medi-Cal |
$2,767.86
|
| Rate for Payer: IEHP Medicare Advantage |
$339.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$645.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$428.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$428.00
|
| Rate for Payer: Multiplan Commercial |
$3,094.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$373.65
|
| Rate for Payer: TriValley Medical Group Senior |
$339.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,504.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,378.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.65
|
| Rate for Payer: Vantage Medical Group Senior |
$339.68
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION [36591]
|
Facility
OP
|
$8.40
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$60.67 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.67
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
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 |
$8.24
|
| 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 |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
|
|
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION. [40836591]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$60.67 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.67
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| 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 Senior |
$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: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| 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
OP
|
$12.00
|
|
|
Service Code
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$60.67 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.67
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| 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 Senior |
$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: IEHP Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| 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
|
CPT J2469
|
| Hospital Charge Code |
1720944
|
|
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 |
$8.24
|
| 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 |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| 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 |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
|
|
PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION [32589]
|
Facility
OP
|
$3.24
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32589
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$527.47 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.47
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.68
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: Dignity Health Senior |
$2.75
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| 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 |
$1.43
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
OP
|
$22.55
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1759468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$527.47 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.47
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.68
|
| 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 Senior |
$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: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$8.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: Vantage Medical Group Senior |
$19.17
|
|
|
PAMIDRONATE 30 MG INTRAVENOUS SOLUTION [10845]
|
Facility
IP
|
$22.55
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1759468
|
|
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 |
$15.49
|
| 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 |
$15.27
|
| Rate for Payer: Heritage Provider Network Senior |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$8.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.53
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
IP
|
$4.09
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1755744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.81
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.37
|
|
|
PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION [33886]
|
Facility
OP
|
$4.09
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
1755744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$527.47 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.47
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.68
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
IP
|
$12.67
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.70
|
| 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: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.58
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| 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 |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.23
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
OP
|
$12.67
|
|
|
Service Code
|
CPT J2430
|
| Hospital Charge Code |
NDG32855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$527.47 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.47
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.68
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.17
|
| 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 Medi-Cal |
$10.77
|
| Rate for Payer: Dignity Health Senior |
$10.77
|
| Rate for Payer: Dignity Health Senior |
$9.55
|
| 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 |
$5.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5.20
|
| Rate for Payer: Heritage Provider Network Senior |
$5.87
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: IEHP Medi-Cal |
$20.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.75
|
| 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 |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10.77
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$69,930.25
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$69,930.25 |
| Max. Negotiated Rate |
$69,930.25 |
| Rate for Payer: IEHP Medi-Cal |
$69,930.25
|
|
|
PANCREAS TRANSPLANT
|
Facility
IP
|
$114,564.26
|
|
|
Service Code
|
APR-DRG 0064
|
| Min. Negotiated Rate |
$114,564.26 |
| Max. Negotiated Rate |
$114,564.26 |
| Rate for Payer: IEHP Medi-Cal |
$114,564.26
|
|
