|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]
|
Facility
|
OP
|
$2,269.40
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$453.88 |
| Max. Negotiated Rate |
$10,505.29 |
| Rate for Payer: Adventist Health Commercial |
$453.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,505.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,058.41
|
| Rate for Payer: Cash Price |
$1,021.23
|
| Rate for Payer: Cash Price |
$1,021.23
|
| Rate for Payer: Cigna of CA HMO |
$1,588.58
|
| Rate for Payer: Cigna of CA PPO |
$1,588.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,588.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.39
|
| Rate for Payer: Galaxy Health WC |
$1,928.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,361.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,019.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,841.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,359.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,577.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,319.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,467.29
|
| Rate for Payer: Multiplan Commercial |
$1,815.52
|
| Rate for Payer: Networks By Design Commercial |
$1,134.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,928.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,361.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,361.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.71
|
| Rate for Payer: United Healthcare All Other HMO |
$829.01
|
| Rate for Payer: United Healthcare HMO Rider |
$811.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,841.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.39
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]
|
Facility
|
IP
|
$2,269.40
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$453.88 |
| Max. Negotiated Rate |
$1,928.99 |
| Rate for Payer: EPIC Health Plan Senior |
$907.76
|
| Rate for Payer: Galaxy Health WC |
$1,928.99
|
| Rate for Payer: Adventist Health Commercial |
$453.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,745.17
|
| Rate for Payer: Cash Price |
$1,021.23
|
| Rate for Payer: Cigna of CA HMO |
$1,588.58
|
| Rate for Payer: Cigna of CA PPO |
$1,588.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,588.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$907.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1,361.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,338.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.66
|
| Rate for Payer: Multiplan Commercial |
$1,815.52
|
| Rate for Payer: Networks By Design Commercial |
$1,134.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,928.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.71
|
| Rate for Payer: United Healthcare All Other HMO |
$829.01
|
| Rate for Payer: United Healthcare HMO Rider |
$811.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.23
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]
|
Facility
|
IP
|
$542.03
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$460.73 |
| Rate for Payer: Adventist Health Commercial |
$108.41
|
| Rate for Payer: Blue Shield of California Commercial |
$274.81
|
| Rate for Payer: Blue Shield of California Commercial |
$416.82
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Cigna of CA HMO |
$379.42
|
| Rate for Payer: Cigna of CA PPO |
$379.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.81
|
| Rate for Payer: EPIC Health Plan Senior |
$216.81
|
| Rate for Payer: Galaxy Health WC |
$460.73
|
| Rate for Payer: Global Benefits Group Commercial |
$325.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.09
|
| Rate for Payer: Multiplan Commercial |
$433.62
|
| Rate for Payer: Networks By Design Commercial |
$271.01
|
| Rate for Payer: Prime Health Services Commercial |
$460.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.42
|
| Rate for Payer: United Healthcare All Other HMO |
$198.00
|
| Rate for Payer: United Healthcare HMO Rider |
$193.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.51
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]
|
Facility
|
OP
|
$542.03
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$1,370.60 |
| Rate for Payer: Adventist Health Commercial |
$108.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.60
|
| Rate for Payer: Blue Shield of California Commercial |
$542.03
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Cigna of CA HMO |
$379.42
|
| Rate for Payer: Cigna of CA PPO |
$379.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$460.73
|
| Rate for Payer: Global Benefits Group Commercial |
$325.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$433.62
|
| Rate for Payer: Networks By Design Commercial |
$271.01
|
| Rate for Payer: Prime Health Services Commercial |
$460.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.42
|
| Rate for Payer: United Healthcare All Other HMO |
$198.00
|
| Rate for Payer: United Healthcare HMO Rider |
$193.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [187503]
|
Facility
|
OP
|
$2,704.36
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$2,298.71 |
| Rate for Payer: Adventist Health Commercial |
$540.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.60
|
| Rate for Payer: Blue Shield of California Commercial |
$542.03
|
| Rate for Payer: Cash Price |
$1,216.96
|
| Rate for Payer: Cash Price |
$1,216.96
|
| Rate for Payer: Cigna of CA HMO |
$1,893.05
|
| Rate for Payer: Cigna of CA PPO |
$1,893.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,893.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$2,298.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1,622.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,717.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$2,163.49
|
| Rate for Payer: Networks By Design Commercial |
$1,352.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,298.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,622.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,622.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.95
|
| Rate for Payer: United Healthcare All Other HMO |
$987.90
|
| Rate for Payer: United Healthcare HMO Rider |
$966.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [187503]
|
Facility
|
IP
|
$2,704.36
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$540.87 |
| Max. Negotiated Rate |
$2,298.71 |
| Rate for Payer: Adventist Health Commercial |
$540.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,371.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,079.65
|
| Rate for Payer: Cash Price |
$1,216.96
|
| Rate for Payer: Cigna of CA HMO |
$1,893.05
|
| Rate for Payer: Cigna of CA PPO |
$1,893.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,893.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,081.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1,081.74
|
| Rate for Payer: Galaxy Health WC |
$2,298.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1,622.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,717.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,595.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.05
|
| Rate for Payer: Multiplan Commercial |
$2,163.49
|
| Rate for Payer: Networks By Design Commercial |
$1,352.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,298.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.95
|
| Rate for Payer: United Healthcare All Other HMO |
$987.90
|
| Rate for Payer: United Healthcare HMO Rider |
$966.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.68
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT [27123]
|
Facility
|
OP
|
$2,730.11
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$2,320.59 |
| Rate for Payer: Adventist Health Commercial |
$546.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.60
|
| Rate for Payer: Blue Shield of California Commercial |
$542.03
|
| Rate for Payer: Cash Price |
$1,228.55
|
| Rate for Payer: Cash Price |
$1,228.55
|
| Rate for Payer: Cigna of CA HMO |
$1,911.08
|
| Rate for Payer: Cigna of CA PPO |
$1,911.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$2,320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,733.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$2,184.09
|
| Rate for Payer: Networks By Design Commercial |
$1,365.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.61
|
| Rate for Payer: United Healthcare All Other HMO |
$997.31
|
| Rate for Payer: United Healthcare HMO Rider |
$975.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT [27123]
|
Facility
|
IP
|
$2,730.11
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$546.02 |
| Max. Negotiated Rate |
$2,320.59 |
| Rate for Payer: Adventist Health Commercial |
$546.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,099.45
|
| Rate for Payer: Cash Price |
$1,228.55
|
| Rate for Payer: Cigna of CA HMO |
$1,911.08
|
| Rate for Payer: Cigna of CA PPO |
$1,911.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.04
|
| Rate for Payer: Galaxy Health WC |
$2,320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,733.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,610.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.23
|
| Rate for Payer: Multiplan Commercial |
$2,184.09
|
| Rate for Payer: Networks By Design Commercial |
$1,365.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.61
|
| Rate for Payer: United Healthcare All Other HMO |
$997.31
|
| Rate for Payer: United Healthcare HMO Rider |
$975.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.11
|
|
|
LEUPROLIDE ACETATE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21044]
|
Facility
|
IP
|
$6,808.25
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,361.65 |
| Max. Negotiated Rate |
$5,787.01 |
| Rate for Payer: Adventist Health Commercial |
$1,361.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3,451.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,235.54
|
| Rate for Payer: Cash Price |
$3,063.71
|
| Rate for Payer: Cigna of CA HMO |
$4,765.77
|
| Rate for Payer: Cigna of CA PPO |
$4,765.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,765.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,723.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2,723.30
|
| Rate for Payer: Galaxy Health WC |
$5,787.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4,084.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,323.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.98
|
| Rate for Payer: Multiplan Commercial |
$5,446.60
|
| Rate for Payer: Networks By Design Commercial |
$3,404.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,787.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,555.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2,487.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,433.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,229.70
|
|
|
LEUPROLIDE ACETATE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21044]
|
Facility
|
OP
|
$6,808.25
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,147.72 |
| Max. Negotiated Rate |
$10,505.29 |
| Rate for Payer: Adventist Health Commercial |
$1,361.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,505.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,058.41
|
| Rate for Payer: Cash Price |
$3,063.71
|
| Rate for Payer: Cash Price |
$3,063.71
|
| Rate for Payer: Cigna of CA HMO |
$4,765.77
|
| Rate for Payer: Cigna of CA PPO |
$4,765.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,765.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.39
|
| Rate for Payer: Galaxy Health WC |
$5,787.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4,084.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,019.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,841.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,323.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,359.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,577.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,319.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,467.29
|
| Rate for Payer: Multiplan Commercial |
$5,446.60
|
| Rate for Payer: Networks By Design Commercial |
$3,404.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,787.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,084.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,084.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,555.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2,487.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,433.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,229.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,841.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.39
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21045]
|
Facility
|
IP
|
$8,112.98
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,622.60 |
| Max. Negotiated Rate |
$6,896.03 |
| Rate for Payer: EPIC Health Plan Commercial |
$3,245.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3,245.19
|
| Rate for Payer: Galaxy Health WC |
$6,896.03
|
| Rate for Payer: Adventist Health Commercial |
$1,622.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,113.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6,238.88
|
| Rate for Payer: Cash Price |
$3,650.84
|
| Rate for Payer: Cigna of CA HMO |
$5,679.09
|
| Rate for Payer: Cigna of CA PPO |
$5,679.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,679.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4,867.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,151.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,786.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,947.12
|
| Rate for Payer: Multiplan Commercial |
$6,490.38
|
| Rate for Payer: Networks By Design Commercial |
$4,056.49
|
| Rate for Payer: Prime Health Services Commercial |
$6,896.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,044.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,899.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,657.00
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21045]
|
Facility
|
OP
|
$8,112.98
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$6,896.03 |
| Rate for Payer: Adventist Health Commercial |
$1,622.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.60
|
| Rate for Payer: Blue Shield of California Commercial |
$542.03
|
| Rate for Payer: Cash Price |
$3,650.84
|
| Rate for Payer: Cash Price |
$3,650.84
|
| Rate for Payer: Cigna of CA HMO |
$5,679.09
|
| Rate for Payer: Cigna of CA PPO |
$5,679.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,679.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$6,896.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4,867.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,151.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,947.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$6,490.38
|
| Rate for Payer: Networks By Design Commercial |
$4,056.49
|
| Rate for Payer: Prime Health Services Commercial |
$6,896.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,867.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,867.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,044.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,899.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,657.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]
|
Facility
|
OP
|
$1,626.08
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$1,382.17 |
| Rate for Payer: Adventist Health Commercial |
$325.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.60
|
| Rate for Payer: Blue Shield of California Commercial |
$542.03
|
| Rate for Payer: Cash Price |
$731.74
|
| Rate for Payer: Cash Price |
$731.74
|
| Rate for Payer: Cigna of CA HMO |
$1,138.26
|
| Rate for Payer: Cigna of CA PPO |
$1,138.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$1,382.17
|
| Rate for Payer: Global Benefits Group Commercial |
$975.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$1,300.86
|
| Rate for Payer: Networks By Design Commercial |
$813.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.27
|
| Rate for Payer: United Healthcare All Other HMO |
$594.01
|
| Rate for Payer: United Healthcare HMO Rider |
$581.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]
|
Facility
|
IP
|
$1,626.08
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.22 |
| Max. Negotiated Rate |
$1,382.17 |
| Rate for Payer: Adventist Health Commercial |
$325.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,250.46
|
| Rate for Payer: Blue Shield of California Commercial |
$824.42
|
| Rate for Payer: Cash Price |
$731.74
|
| Rate for Payer: Cigna of CA HMO |
$1,138.26
|
| Rate for Payer: Cigna of CA PPO |
$1,138.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.43
|
| Rate for Payer: EPIC Health Plan Senior |
$650.43
|
| Rate for Payer: Galaxy Health WC |
$1,382.17
|
| Rate for Payer: Global Benefits Group Commercial |
$975.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.26
|
| Rate for Payer: Multiplan Commercial |
$1,300.86
|
| Rate for Payer: Networks By Design Commercial |
$813.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.27
|
| Rate for Payer: United Healthcare All Other HMO |
$594.01
|
| Rate for Payer: United Healthcare HMO Rider |
$581.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.54
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT [153492]
|
Facility
|
OP
|
$16,226.27
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$13,792.33 |
| Rate for Payer: Adventist Health Commercial |
$3,245.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.60
|
| Rate for Payer: Blue Shield of California Commercial |
$542.03
|
| Rate for Payer: Cash Price |
$7,301.82
|
| Rate for Payer: Cash Price |
$7,301.82
|
| Rate for Payer: Cigna of CA HMO |
$11,358.39
|
| Rate for Payer: Cigna of CA PPO |
$11,358.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,358.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$13,792.33
|
| Rate for Payer: Global Benefits Group Commercial |
$9,735.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,303.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,894.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$12,981.02
|
| Rate for Payer: Networks By Design Commercial |
$8,113.14
|
| Rate for Payer: Prime Health Services Commercial |
$13,792.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,735.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,735.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,089.72
|
| Rate for Payer: United Healthcare All Other HMO |
$5,927.46
|
| Rate for Payer: United Healthcare HMO Rider |
$5,799.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,314.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT [153492]
|
Facility
|
IP
|
$16,226.27
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,245.25 |
| Max. Negotiated Rate |
$13,792.33 |
| Rate for Payer: Adventist Health Commercial |
$3,245.25
|
| Rate for Payer: Blue Shield of California Commercial |
$12,478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,226.72
|
| Rate for Payer: Cash Price |
$7,301.82
|
| Rate for Payer: Cigna of CA HMO |
$11,358.39
|
| Rate for Payer: Cigna of CA PPO |
$11,358.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,358.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,490.51
|
| Rate for Payer: EPIC Health Plan Senior |
$6,490.51
|
| Rate for Payer: Galaxy Health WC |
$13,792.33
|
| Rate for Payer: Global Benefits Group Commercial |
$9,735.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,303.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,573.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,894.30
|
| Rate for Payer: Multiplan Commercial |
$12,981.02
|
| Rate for Payer: Networks By Design Commercial |
$8,113.14
|
| Rate for Payer: Prime Health Services Commercial |
$13,792.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,089.72
|
| Rate for Payer: United Healthcare All Other HMO |
$5,927.46
|
| Rate for Payer: United Healthcare HMO Rider |
$5,799.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,314.10
|
|
|
LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 0093414845
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
|
LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 0093414845
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION (INTERMITTENT) [40856278]
|
Facility
|
OP
|
$6.43
|
|
|
Service Code
|
NDC 9940856978
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.13
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$5.14
|
| Rate for Payer: Networks By Design Commercial |
$4.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO |
$3.21
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION (INTERMITTENT) [40856278]
|
Facility
|
IP
|
$6.43
|
|
|
Service Code
|
NDC 9940856978
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4.94
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.14
|
| Rate for Payer: Networks By Design Commercial |
$4.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
|
|
LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [154435]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
|
|
LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK [154435]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION [36590]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 7109314413
|
| 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
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION [36590]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 3172257447
|
| 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
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION [36590]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 3172257447
|
| 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: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| 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: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| 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 Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| 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 |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
