|
MUPIROCIN 2 % TOPICAL OINTMENT [10674]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 5167213120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT [10674]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 4580211222
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$79,551.65
|
|
|
Service Code
|
APR-DRG 9123
|
| Min. Negotiated Rate |
$63,536.65 |
| Max. Negotiated Rate |
$79,551.65 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63,536.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79,551.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,177.79
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$173,693.17
|
|
|
Service Code
|
APR-DRG 9124
|
| Min. Negotiated Rate |
$138,726.00 |
| Max. Negotiated Rate |
$173,693.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138,726.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173,693.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155,409.68
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$42,106.15
|
|
|
Service Code
|
APR-DRG 9121
|
| Min. Negotiated Rate |
$33,629.51 |
| Max. Negotiated Rate |
$42,106.15 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,629.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,106.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,673.92
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$54,897.04
|
|
|
Service Code
|
APR-DRG 9122
|
| Min. Negotiated Rate |
$43,845.40 |
| Max. Negotiated Rate |
$54,897.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,845.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54,897.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,118.41
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$16,934.91
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$13,525.64 |
| Max. Negotiated Rate |
$16,934.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,934.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,152.29
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$60,517.85
|
|
|
Service Code
|
APR-DRG 3434
|
| Min. Negotiated Rate |
$48,334.65 |
| Max. Negotiated Rate |
$60,517.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48,334.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60,517.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,147.55
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$29,505.58
|
|
|
Service Code
|
APR-DRG 3433
|
| Min. Negotiated Rate |
$23,565.64 |
| Max. Negotiated Rate |
$29,505.58 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,565.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,505.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,399.72
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$19,974.93
|
|
|
Service Code
|
APR-DRG 3432
|
| Min. Negotiated Rate |
$15,953.66 |
| Max. Negotiated Rate |
$19,974.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,953.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,974.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,872.30
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [196255]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [196255]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
MVI ADULT WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION. [40810661]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
|
|
MVI ADULT WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION. [40810661]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.29
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.74
|
| Rate for Payer: Galaxy Health WC |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1.57
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [117200]
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA HMO |
$4.13
|
| Rate for Payer: Cigna of CA PPO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Galaxy Health WC |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Global Benefits Group Commercial |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Prime Health Services Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN [117200]
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$4.13
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$4.90
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Global Benefits Group Commercial |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Prime Health Services Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.93
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION [23968]
|
Facility
|
OP
|
$129.57
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$110.13 |
| Rate for Payer: Adventist Health Commercial |
$25.91
|
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$58.31
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$58.31
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO |
$60.90
|
| Rate for Payer: Cigna of CA HMO |
$90.70
|
| Rate for Payer: Cigna of CA PPO |
$60.90
|
| Rate for Payer: Cigna of CA PPO |
$90.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$51.83
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Galaxy Health WC |
$110.13
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Global Benefits Group Commercial |
$77.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$103.66
|
| Rate for Payer: Networks By Design Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$64.78
|
| Rate for Payer: Prime Health Services Commercial |
$110.13
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.65
|
| Rate for Payer: United Healthcare All Other HMO |
$47.33
|
| Rate for Payer: United Healthcare All Other HMO |
$31.78
|
| Rate for Payer: United Healthcare HMO Rider |
$31.09
|
| Rate for Payer: United Healthcare HMO Rider |
$46.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$110.13
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION [23968]
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS J7519
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Commercial |
$25.91
|
| Rate for Payer: Blue Shield of California Commercial |
$99.64
|
| Rate for Payer: Blue Shield of California Commercial |
$44.11
|
| Rate for Payer: Blue Shield of California Commercial |
$66.90
|
| Rate for Payer: Blue Shield of California Commercial |
$65.69
|
| Rate for Payer: Cash Price |
$58.31
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO |
$60.90
|
| Rate for Payer: Cigna of CA HMO |
$90.70
|
| Rate for Payer: Cigna of CA PPO |
$90.70
|
| Rate for Payer: Cigna of CA PPO |
$60.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$51.83
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$110.13
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Global Benefits Group Commercial |
$77.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$103.66
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$64.78
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Prime Health Services Commercial |
$110.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.65
|
| Rate for Payer: United Healthcare All Other HMO |
$31.78
|
| Rate for Payer: United Healthcare All Other HMO |
$47.33
|
| Rate for Payer: United Healthcare HMO Rider |
$46.31
|
| Rate for Payer: United Healthcare HMO Rider |
$31.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.49
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
HCPCS J7528
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.64
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$2.88
|
|
|
MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION [25005]
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
HCPCS J7528
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$0.78
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.36
|
| Rate for Payer: Galaxy Health WC |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.65
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.54
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$0.65
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
|
|
MYCOPHENOLATE MOFETIL 500 MG TABLET [21374]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.35
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
|
|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE [38062]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Adventist Health Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$6.39
|
| Rate for Payer: Cigna of CA HMO |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$6.39
|
| Rate for Payer: Cigna of CA PPO |
$3.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$3.65
|
| Rate for Payer: Galaxy Health WC |
$7.76
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$3.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Networks By Design Commercial |
$2.23
|
| Rate for Payer: Networks By Design Commercial |
$4.57
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$3.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.43
|
| Rate for Payer: United Healthcare All Other HMO |
$3.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
|
