|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$337.15 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.15
|
| Rate for Payer: Blue Shield of California Commercial |
$44.09
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
IP
|
$69.66
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$59.21 |
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$33.91
|
| Rate for Payer: Blue Shield of California Commercial |
$35.32
|
| Rate for Payer: Blue Shield of California Commercial |
$53.57
|
| Rate for Payer: Blue Shield of California Commercial |
$22.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.72
|
| Rate for Payer: Multiplan Commercial |
$35.27
|
| Rate for Payer: Multiplan Commercial |
$55.73
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$22.05
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.14
|
| Rate for Payer: United Healthcare All Other HMO |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$24.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.81
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$337.15 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.15
|
| Rate for Payer: Blue Shield of California Commercial |
$44.09
|
| Rate for Payer: Blue Shield of California Commercial |
$44.09
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Senior |
$27.86
|
| Rate for Payer: EPIC Health Plan Senior |
$17.64
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$55.73
|
| Rate for Payer: Multiplan Commercial |
$35.27
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$22.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.14
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare All Other HMO |
$25.45
|
| Rate for Payer: United Healthcare HMO Rider |
$24.90
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$337.15 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.15
|
| Rate for Payer: Blue Shield of California Commercial |
$44.09
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO |
$90.33
|
| Rate for Payer: Cigna of CA PPO |
$90.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Senior |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.33
|
| Rate for Payer: Multiplan Commercial |
$103.24
|
| Rate for Payer: Networks By Design Commercial |
$64.53
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.14
|
| Rate for Payer: United Healthcare HMO Rider |
$46.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.69
|
| Rate for Payer: Vantage Medical Group Senior |
$109.69
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$109.69 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Blue Shield of California Commercial |
$65.43
|
| Rate for Payer: Blue Shield of California Commercial |
$99.24
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO |
$90.33
|
| Rate for Payer: Cigna of CA PPO |
$90.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Senior |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.97
|
| Rate for Payer: Multiplan Commercial |
$103.24
|
| Rate for Payer: Networks By Design Commercial |
$64.53
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.14
|
| Rate for Payer: United Healthcare HMO Rider |
$46.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.26
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$160.41 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.41
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
IP
|
$4.55
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$160.41 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.41
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Galaxy Health WC |
$4.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Networks By Design Commercial |
$3.38
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.42
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Galaxy Health WC |
$4.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Networks By Design Commercial |
$3.38
|
| Rate for Payer: Prime Health Services Commercial |
$4.42
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION [241932]
|
Facility
|
OP
|
$12,772.56
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$10,856.68 |
| Rate for Payer: Adventist Health Commercial |
$2,554.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.30
|
| Rate for Payer: Blue Shield of California Commercial |
$63.09
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cigna of CA HMO |
$8,940.79
|
| Rate for Payer: Cigna of CA PPO |
$8,940.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,940.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.22
|
| Rate for Payer: EPIC Health Plan Senior |
$65.48
|
| Rate for Payer: Galaxy Health WC |
$10,856.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7,663.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,110.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,065.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.77
|
| Rate for Payer: Multiplan Commercial |
$10,218.05
|
| Rate for Payer: Networks By Design Commercial |
$6,386.28
|
| Rate for Payer: Prime Health Services Commercial |
$10,856.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,663.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,663.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,793.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4,665.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4,564.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,183.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$59.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Vantage Medical Group Senior |
$65.48
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION [241932]
|
Facility
|
IP
|
$12,772.56
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,554.51 |
| Max. Negotiated Rate |
$10,856.68 |
| Rate for Payer: Adventist Health Commercial |
$2,554.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6,475.69
|
| Rate for Payer: Blue Shield of California Commercial |
$9,822.10
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cigna of CA HMO |
$8,940.79
|
| Rate for Payer: Cigna of CA PPO |
$8,940.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,940.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,109.02
|
| Rate for Payer: EPIC Health Plan Senior |
$5,109.02
|
| Rate for Payer: Galaxy Health WC |
$10,856.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7,663.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,110.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,535.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,065.41
|
| Rate for Payer: Multiplan Commercial |
$10,218.05
|
| Rate for Payer: Networks By Design Commercial |
$6,386.28
|
| Rate for Payer: Prime Health Services Commercial |
$10,856.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,793.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4,665.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4,564.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,183.01
|
|
|
IMETELSTAT 47 MG INTRAVENOUS SOLUTION [241930]
|
Facility
|
OP
|
$3,193.14
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$2,714.17 |
| Rate for Payer: Adventist Health Commercial |
$638.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.30
|
| Rate for Payer: Blue Shield of California Commercial |
$63.09
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cigna of CA HMO |
$2,235.20
|
| Rate for Payer: Cigna of CA PPO |
$2,235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.22
|
| Rate for Payer: EPIC Health Plan Senior |
$65.48
|
| Rate for Payer: Galaxy Health WC |
$2,714.17
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.77
|
| Rate for Payer: Multiplan Commercial |
$2,554.51
|
| Rate for Payer: Networks By Design Commercial |
$1,596.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$59.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Vantage Medical Group Senior |
$65.48
|
|
|
IMETELSTAT 47 MG INTRAVENOUS SOLUTION [241930]
|
Facility
|
IP
|
$3,193.14
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$638.63 |
| Max. Negotiated Rate |
$2,714.17 |
| Rate for Payer: Adventist Health Commercial |
$638.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,618.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,455.52
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cigna of CA HMO |
$2,235.20
|
| Rate for Payer: Cigna of CA PPO |
$2,235.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.26
|
| Rate for Payer: Galaxy Health WC |
$2,714.17
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.35
|
| Rate for Payer: Multiplan Commercial |
$2,554.51
|
| Rate for Payer: Networks By Design Commercial |
$1,596.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.75
|
|
|
IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION [26431]
|
Facility
|
IP
|
$2,101.76
|
|
|
Service Code
|
HCPCS J1786
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$420.35 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Adventist Health Commercial |
$420.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,065.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.25
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cigna of CA HMO |
$1,471.23
|
| Rate for Payer: Cigna of CA PPO |
$1,471.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,471.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$840.70
|
| Rate for Payer: EPIC Health Plan Senior |
$840.70
|
| Rate for Payer: Galaxy Health WC |
$1,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,334.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,240.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.42
|
| Rate for Payer: Multiplan Commercial |
$1,681.41
|
| Rate for Payer: Networks By Design Commercial |
$1,050.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,786.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$788.79
|
| Rate for Payer: United Healthcare All Other HMO |
$767.77
|
| Rate for Payer: United Healthcare HMO Rider |
$751.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$688.33
|
|
|
IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION [26431]
|
Facility
|
OP
|
$2,101.76
|
|
|
Service Code
|
HCPCS J1786
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.33 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Cigna of CA PPO |
$1,471.23
|
| Rate for Payer: Adventist Health Commercial |
$420.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.34
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cigna of CA HMO |
$1,471.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,471.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.49
|
| Rate for Payer: EPIC Health Plan Senior |
$47.66
|
| Rate for Payer: Galaxy Health WC |
$1,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,261.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,334.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$1,681.41
|
| Rate for Payer: Networks By Design Commercial |
$1,050.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,786.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,261.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,261.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$788.79
|
| Rate for Payer: United Healthcare All Other HMO |
$767.77
|
| Rate for Payer: United Healthcare HMO Rider |
$751.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$688.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.66
|
| Rate for Payer: Vantage Medical Group Senior |
$47.66
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
IP
|
$20.51
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$10.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
OP
|
$20.51
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$46.14 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.26
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.36
|
| Rate for Payer: Multiplan Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$10.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.43
|
| Rate for Payer: Vantage Medical Group Senior |
$17.43
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$46.14 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.26
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Senior |
$13.13
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Multiplan Commercial |
$26.26
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.86
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.90
|
| Rate for Payer: Vantage Medical Group Senior |
$30.58
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.58 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California Commercial |
$25.24
|
| Rate for Payer: Blue Shield of California Commercial |
$18.24
|
| Rate for Payer: Blue Shield of California Commercial |
$27.67
|
| Rate for Payer: Blue Shield of California Commercial |
$16.64
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$16.19
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Senior |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$12.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.78
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 6958442510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 6958442510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 6931513301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 6931513301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6958442610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
