|
PROCAINAMIDE 500 MG/ML INJECTION SOLUTION [6563]
|
Facility
OP
|
$43.66
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
1720217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$359.45 |
| Rate for Payer: Adventist Health Commercial |
$8.73
|
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$359.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$359.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$160.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.66
|
| Rate for Payer: Blue Shield of California Commercial |
$350.72
|
| Rate for Payer: Blue Shield of California Commercial |
$350.72
|
| Rate for Payer: Blue Shield of California EPN |
$350.72
|
| Rate for Payer: Blue Shield of California EPN |
$350.72
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.95
|
| Rate for Payer: Dignity Health Senior |
$160.95
|
| Rate for Payer: Dignity Health Senior |
$160.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$146.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$146.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.68
|
| Rate for Payer: Heritage Provider Network Senior |
$166.68
|
| Rate for Payer: Heritage Provider Network Senior |
$20.21
|
| Rate for Payer: Humana Medicare |
$146.32
|
| Rate for Payer: Humana Medicare |
$146.32
|
| Rate for Payer: IEHP Medi-Cal |
$235.22
|
| Rate for Payer: IEHP Medi-Cal |
$235.22
|
| Rate for Payer: IEHP Medicare Advantage |
$146.32
|
| Rate for Payer: IEHP Medicare Advantage |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$278.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.36
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$32.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$160.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$160.95
|
| Rate for Payer: TriValley Medical Group Senior |
$146.32
|
| Rate for Payer: TriValley Medical Group Senior |
$146.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$131.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.95
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
| Rate for Payer: Vantage Medical Group Senior |
$146.32
|
|
|
PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]
|
Facility
IP
|
$1.29
|
|
|
Service Code
|
NDC 9994-0804-40
|
| Hospital Charge Code |
1715897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.87
|
| Rate for Payer: Heritage Provider Network Senior |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
|
|
PROCAINAMIDE ORAL SOLUTION (IV FORM) 50 MG/ML [4080440]
|
Facility
OP
|
$1.29
|
|
|
Service Code
|
NDC 9994-0804-40
|
| Hospital Charge Code |
1715897
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.76
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Senior |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]
|
Facility
OP
|
$12.07
|
|
|
Service Code
|
NDC 9994-0803-23
|
| Hospital Charge Code |
1715155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Blue Shield of California EPN |
$7.09
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.26
|
| Rate for Payer: Dignity Health Senior |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.47
|
| Rate for Payer: Heritage Provider Network Senior |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$9.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.26
|
| Rate for Payer: Vantage Medical Group Senior |
$10.26
|
|
|
PROCARBAZINE ORAL SUSPENSION COMPOUND 10 MG/ML [4080323]
|
Facility
IP
|
$12.07
|
|
|
Service Code
|
NDC 9994-0803-23
|
| Hospital Charge Code |
1715155
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.05 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$9.05
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$16,559.05
|
|
|
Service Code
|
APR-DRG 4033
|
| Min. Negotiated Rate |
$16,559.05 |
| Max. Negotiated Rate |
$16,559.05 |
| Rate for Payer: IEHP Medi-Cal |
$16,559.05
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$11,607.45
|
|
|
Service Code
|
APR-DRG 4032
|
| Min. Negotiated Rate |
$11,607.45 |
| Max. Negotiated Rate |
$11,607.45 |
| Rate for Payer: IEHP Medi-Cal |
$11,607.45
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$33,821.49
|
|
|
Service Code
|
APR-DRG 4034
|
| Min. Negotiated Rate |
$33,821.49 |
| Max. Negotiated Rate |
$33,821.49 |
| Rate for Payer: IEHP Medi-Cal |
$33,821.49
|
|
|
PROCEDURES FOR OBESITY
|
Facility
IP
|
$9,997.71
|
|
|
Service Code
|
APR-DRG 4031
|
| Min. Negotiated Rate |
$9,997.71 |
| Max. Negotiated Rate |
$9,997.71 |
| Rate for Payer: IEHP Medi-Cal |
$9,997.71
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$20,053.13
|
|
|
Service Code
|
APR-DRG 8502
|
| Min. Negotiated Rate |
$20,053.13 |
| Max. Negotiated Rate |
$20,053.13 |
| Rate for Payer: IEHP Medi-Cal |
$20,053.13
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$14,786.14
|
|
|
Service Code
|
APR-DRG 8501
|
| Min. Negotiated Rate |
$14,786.14 |
| Max. Negotiated Rate |
$14,786.14 |
| Rate for Payer: IEHP Medi-Cal |
$14,786.14
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$24,582.88
|
|
|
Service Code
|
APR-DRG 8503
|
| Min. Negotiated Rate |
$24,582.88 |
| Max. Negotiated Rate |
$24,582.88 |
| Rate for Payer: IEHP Medi-Cal |
$24,582.88
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES
|
Facility
IP
|
$52,228.07
|
|
|
Service Code
|
APR-DRG 8504
|
| Min. Negotiated Rate |
$52,228.07 |
| Max. Negotiated Rate |
$52,228.07 |
| Rate for Payer: IEHP Medi-Cal |
$52,228.07
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
OP
|
$10.46
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$7.84 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.19
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.08
|
| Rate for Payer: Heritage Provider Network Senior |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
OP
|
$10.46
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [11138]
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
1748022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$7.84 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.19
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.08
|
| Rate for Payer: Heritage Provider Network Senior |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [153823]
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
1720454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.84
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION [153823]
|
Facility
OP
|
$3.81
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
1720454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.48
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.36
|
| Rate for Payer: Dignity Health Senior |
$3.24
|
| Rate for Payer: Dignity Health Senior |
$4.68
|
| Rate for Payer: Dignity Health Senior |
$4.59
|
| Rate for Payer: Dignity Health Senior |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2.55
|
| Rate for Payer: IEHP Medi-Cal |
$12.31
|
| Rate for Payer: IEHP Medi-Cal |
$12.31
|
| Rate for Payer: IEHP Medi-Cal |
$12.31
|
| Rate for Payer: IEHP Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.36
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.36
|
| Rate for Payer: Vantage Medical Group Senior |
$4.68
|
|
|
PROCHLORPERAZINE EDISYLATE 5 MG/ML INJECTION SOLUTION [6580]
|
Facility
OP
|
$2.79
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
NDG6580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.37
|
| Rate for Payer: Dignity Health Senior |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1.29
|
| Rate for Payer: IEHP Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
PROCHLORPERAZINE EDISYLATE 5 MG/ML INJECTION SOLUTION [6580]
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
NDG6580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.93
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
OP
|
$1.77
|
|
|
Service Code
|
NDC 50268-685-11
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.50
|
| Rate for Payer: Dignity Health Senior |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1.50
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
IP
|
$1.77
|
|
|
Service Code
|
NDC 50268-685-11
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Senior |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET [6582]
|
Facility
OP
|
$0.63
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
1710783
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Senior |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
