|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$38,823.83
|
|
|
Service Code
|
APR-DRG 1704
|
| Min. Negotiated Rate |
$38,823.83 |
| Max. Negotiated Rate |
$38,823.83 |
| Rate for Payer: IEHP Medi-Cal |
$38,823.83
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$27,611.34
|
|
|
Service Code
|
APR-DRG 1703
|
| Min. Negotiated Rate |
$27,611.34 |
| Max. Negotiated Rate |
$27,611.34 |
| Rate for Payer: IEHP Medi-Cal |
$27,611.34
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$19,166.67
|
|
|
Service Code
|
APR-DRG 1701
|
| Min. Negotiated Rate |
$19,166.67 |
| Max. Negotiated Rate |
$19,166.67 |
| Rate for Payer: IEHP Medi-Cal |
$19,166.67
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$21,771.31
|
|
|
Service Code
|
APR-DRG 1702
|
| Min. Negotiated Rate |
$21,771.31 |
| Max. Negotiated Rate |
$21,771.31 |
| Rate for Payer: IEHP Medi-Cal |
$21,771.31
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$31,003.95
|
|
|
Service Code
|
APR-DRG 1714
|
| Min. Negotiated Rate |
$31,003.95 |
| Max. Negotiated Rate |
$31,003.95 |
| Rate for Payer: IEHP Medi-Cal |
$31,003.95
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$20,847.05
|
|
|
Service Code
|
APR-DRG 1713
|
| Min. Negotiated Rate |
$20,847.05 |
| Max. Negotiated Rate |
$20,847.05 |
| Rate for Payer: IEHP Medi-Cal |
$20,847.05
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$14,205.12
|
|
|
Service Code
|
APR-DRG 1711
|
| Min. Negotiated Rate |
$14,205.12 |
| Max. Negotiated Rate |
$14,205.12 |
| Rate for Payer: IEHP Medi-Cal |
$14,205.12
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
IP
|
$16,288.44
|
|
|
Service Code
|
APR-DRG 1712
|
| Min. Negotiated Rate |
$16,288.44 |
| Max. Negotiated Rate |
$16,288.44 |
| Rate for Payer: IEHP Medi-Cal |
$16,288.44
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID [10918]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 46122-108-46
|
| Hospital Charge Code |
1719214
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID [10918]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 46122-108-46
|
| Hospital Charge Code |
1719214
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID [10918]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 8770141115
|
| Hospital Charge Code |
1719214
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID [10918]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 63736-024-03
|
| Hospital Charge Code |
1719214
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID [10918]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 63736-024-03
|
| Hospital Charge Code |
1719214
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID [10918]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 8770141115
|
| Hospital Charge Code |
1719214
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
PERMETHRIN 5 % TOPICAL CREAM [10917]
|
Facility
OP
|
$1.98
|
|
|
Service Code
|
NDC 0472-0242-60
|
| Hospital Charge Code |
1743612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: Dignity Health Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
|
|
PERMETHRIN 5 % TOPICAL CREAM [10917]
|
Facility
OP
|
$1.98
|
|
|
Service Code
|
NDC 45802-269-37
|
| Hospital Charge Code |
1743612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: Dignity Health Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
|
|
PERMETHRIN 5 % TOPICAL CREAM [10917]
|
Facility
IP
|
$1.98
|
|
|
Service Code
|
NDC 45802-269-37
|
| Hospital Charge Code |
1743612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
|
|
PERMETHRIN 5 % TOPICAL CREAM [10917]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 21922-021-07
|
| Hospital Charge Code |
1743612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
|
|
PERMETHRIN 5 % TOPICAL CREAM [10917]
|
Facility
IP
|
$1.98
|
|
|
Service Code
|
NDC 0472-0242-60
|
| Hospital Charge Code |
1743612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
|
|
PERMETHRIN 5 % TOPICAL CREAM [10917]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 21922-021-07
|
| Hospital Charge Code |
1743612
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Senior |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
PERPHENAZINE 2 MG TABLET [6157]
|
Facility
IP
|
$0.33
|
|
|
Service Code
|
NDC 64980-290-01
|
| Hospital Charge Code |
1711077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
|
|
PERPHENAZINE 2 MG TABLET [6157]
|
Facility
OP
|
$0.33
|
|
|
Service Code
|
NDC 64980-290-01
|
| Hospital Charge Code |
1711077
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Senior |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN [228328]
|
Facility
OP
|
$1,016.56
|
|
|
Service Code
|
CPT J9316
|
| Hospital Charge Code |
NDG228328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$762.42 |
| Rate for Payer: Adventist Health Commercial |
$203.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$698.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$83.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.84
|
| Rate for Payer: Blue Shield of California Commercial |
$72.00
|
| Rate for Payer: Blue Shield of California EPN |
$72.00
|
| Rate for Payer: Cash Price |
$457.45
|
| Rate for Payer: Cash Price |
$457.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$467.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.76
|
| Rate for Payer: Dignity Health Senior |
$73.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.67
|
| Rate for Payer: Heritage Provider Network Senior |
$470.67
|
| Rate for Payer: Humana Medicare |
$67.05
|
| Rate for Payer: IEHP Medi-Cal |
$111.56
|
| Rate for Payer: IEHP Medicare Advantage |
$67.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.48
|
| Rate for Payer: Multiplan Commercial |
$762.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.76
|
| Rate for Payer: TriValley Medical Group Senior |
$67.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$370.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$339.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.76
|
| Rate for Payer: Vantage Medical Group Senior |
$73.76
|
|
|
PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN [228328]
|
Facility
IP
|
$1,016.56
|
|
|
Service Code
|
CPT J9316
|
| Hospital Charge Code |
NDG228328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$762.42 |
| Rate for Payer: Adventist Health Commercial |
$203.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$698.38
|
| Rate for Payer: Cash Price |
$457.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$467.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$688.21
|
| Rate for Payer: Heritage Provider Network Senior |
$688.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.14
|
| Rate for Payer: Multiplan Commercial |
$762.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$370.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$339.63
|
|
|
PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION [196616]
|
Facility
OP
|
$543.14
|
|
|
Service Code
|
CPT J9306
|
| Hospital Charge Code |
NDG196616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$407.36 |
| Rate for Payer: Adventist Health Commercial |
$108.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.78
|
| Rate for Payer: Blue Shield of California Commercial |
$14.31
|
| Rate for Payer: Blue Shield of California EPN |
$14.31
|
| Rate for Payer: Cash Price |
$244.41
|
| Rate for Payer: Cash Price |
$244.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$249.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.97
|
| Rate for Payer: Dignity Health Senior |
$16.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.47
|
| Rate for Payer: Heritage Provider Network Senior |
$251.47
|
| Rate for Payer: Humana Medicare |
$15.43
|
| Rate for Payer: IEHP Medi-Cal |
$31.03
|
| Rate for Payer: IEHP Medicare Advantage |
$15.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$407.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.97
|
| Rate for Payer: TriValley Medical Group Senior |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$198.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Vantage Medical Group Senior |
$15.43
|
|
