|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 9999053716
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0904727670
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 0121086800
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| 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 Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 0121104516
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| 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 Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 9999053716
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0904727641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 6068780017
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 0121086850
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 5167212631
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM [5754]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 5167212631
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
|
OP
|
$283.51
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$240.98 |
| Rate for Payer: Adventist Health Commercial |
$56.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.81
|
| Rate for Payer: Blue Shield of California Commercial |
$98.90
|
| Rate for Payer: Cash Price |
$127.58
|
| Rate for Payer: Cash Price |
$127.58
|
| Rate for Payer: Cigna of CA HMO |
$198.46
|
| Rate for Payer: Cigna of CA PPO |
$198.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.36
|
| Rate for Payer: EPIC Health Plan Senior |
$92.91
|
| Rate for Payer: Galaxy Health WC |
$240.98
|
| Rate for Payer: Global Benefits Group Commercial |
$170.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$138.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$84.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.18
|
| Rate for Payer: Multiplan Commercial |
$226.81
|
| Rate for Payer: Networks By Design Commercial |
$141.75
|
| Rate for Payer: Prime Health Services Commercial |
$240.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.40
|
| Rate for Payer: United Healthcare All Other HMO |
$103.57
|
| Rate for Payer: United Healthcare HMO Rider |
$101.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$84.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.91
|
| Rate for Payer: Vantage Medical Group Senior |
$92.91
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
|
IP
|
$283.51
|
|
|
Service Code
|
HCPCS J9301
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$240.98 |
| Rate for Payer: Adventist Health Commercial |
$56.70
|
| Rate for Payer: Blue Shield of California Commercial |
$143.74
|
| Rate for Payer: Blue Shield of California Commercial |
$218.02
|
| Rate for Payer: Cash Price |
$127.58
|
| Rate for Payer: Cigna of CA HMO |
$198.46
|
| Rate for Payer: Cigna of CA PPO |
$198.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.40
|
| Rate for Payer: EPIC Health Plan Senior |
$113.40
|
| Rate for Payer: Galaxy Health WC |
$240.98
|
| Rate for Payer: Global Benefits Group Commercial |
$170.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.04
|
| Rate for Payer: Multiplan Commercial |
$226.81
|
| Rate for Payer: Networks By Design Commercial |
$141.75
|
| Rate for Payer: Prime Health Services Commercial |
$240.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.40
|
| Rate for Payer: United Healthcare All Other HMO |
$103.57
|
| Rate for Payer: United Healthcare HMO Rider |
$101.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.85
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$16,055.11
|
|
|
Service Code
|
APR-DRG 7623
|
| Min. Negotiated Rate |
$12,822.97 |
| Max. Negotiated Rate |
$16,055.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,822.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,055.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,365.10
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$24,693.98
|
|
|
Service Code
|
APR-DRG 7624
|
| Min. Negotiated Rate |
$19,722.69 |
| Max. Negotiated Rate |
$24,693.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,722.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,693.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,094.61
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$9,841.33
|
|
|
Service Code
|
APR-DRG 7622
|
| Min. Negotiated Rate |
$7,860.12 |
| Max. Negotiated Rate |
$9,841.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,860.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,841.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,805.41
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$8,439.46
|
|
|
Service Code
|
APR-DRG 7621
|
| Min. Negotiated Rate |
$6,740.46 |
| Max. Negotiated Rate |
$8,439.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,740.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,439.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,551.09
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$101.36 |
| Rate for Payer: Adventist Health Commercial |
$23.85
|
| Rate for Payer: Blue Shield of California Commercial |
$60.46
|
| Rate for Payer: Blue Shield of California Commercial |
$91.70
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$83.47
|
| Rate for Payer: Cigna of CA PPO |
$83.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Senior |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.75
|
| Rate for Payer: United Healthcare All Other HMO |
$43.56
|
| Rate for Payer: United Healthcare HMO Rider |
$42.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.05
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$101.36 |
| Rate for Payer: Adventist Health Commercial |
$23.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$83.47
|
| Rate for Payer: Cigna of CA PPO |
$83.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Senior |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.47
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.75
|
| Rate for Payer: United Healthcare All Other HMO |
$43.56
|
| Rate for Payer: United Healthcare HMO Rider |
$42.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.36
|
| Rate for Payer: Vantage Medical Group Senior |
$101.36
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
|
IP
|
$11.93
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.14 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.05
|
| Rate for Payer: Blue Shield of California Commercial |
$9.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$5.37
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.56
|
| Rate for Payer: EPIC Health Plan Senior |
$4.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$3.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.16
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$9.54
|
| Rate for Payer: Multiplan Commercial |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$5.96
|
| Rate for Payer: Prime Health Services Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$3.31
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$5.37
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$5.37
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$4.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.56
|
| Rate for Payer: Galaxy Health WC |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Galaxy Health WC |
$10.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.16
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$9.54
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Networks By Design Commercial |
$5.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$10.14
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$3.31
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$19.89 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Blue Shield of California Commercial |
$30.23
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$21.29
|
| Rate for Payer: Blue Shield of California Commercial |
$45.86
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$16.38
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$16.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.36
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$23.85
|
| Rate for Payer: Galaxy Health WC |
$50.69
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$19.89
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14.04
|
| Rate for Payer: Global Benefits Group Commercial |
$35.78
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.31
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$29.82
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$50.69
|
| Rate for Payer: Prime Health Services Commercial |
$19.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8.55
|
| Rate for Payer: United Healthcare All Other HMO |
$21.78
|
| Rate for Payer: United Healthcare All Other HMO |
$15.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$21.31
|
| Rate for Payer: United Healthcare HMO Rider |
$15.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.76
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Adventist Health Commercial |
$11.93
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$16.38
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$16.38
|
| Rate for Payer: Cigna of CA PPO |
$41.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.36
|
| Rate for Payer: EPIC Health Plan Senior |
$23.85
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$19.89
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$50.69
|
| Rate for Payer: Global Benefits Group Commercial |
$14.04
|
| Rate for Payer: Global Benefits Group Commercial |
$35.78
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$29.82
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$19.89
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$50.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.76
|
| Rate for Payer: United Healthcare All Other HMO |
$15.34
|
| Rate for Payer: United Healthcare All Other HMO |
$21.78
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$8.55
|
| Rate for Payer: United Healthcare HMO Rider |
$8.36
|
| Rate for Payer: United Healthcare HMO Rider |
$15.01
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$21.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Vantage Medical Group Senior |
$50.69
|
| Rate for Payer: Vantage Medical Group Senior |
$19.89
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$2.44
|
| Rate for Payer: Cigna of CA PPO |
$2.44
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$2.44
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
OCTREOTIDE,MICROSPHERES 20 MG INTRAMUSCULAR WRAP, LONG-ACTING RELEASE [40824435]
|
Facility
|
OP
|
$5,539.56
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.82 |
| Max. Negotiated Rate |
$4,708.63 |
| Rate for Payer: Adventist Health Commercial |
$1,107.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,286.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$239.10
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cash Price |
$2,492.80
|
| Rate for Payer: Cigna of CA HMO |
$3,877.69
|
| Rate for Payer: Cigna of CA PPO |
$3,877.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,877.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.37
|
| Rate for Payer: EPIC Health Plan Senior |
$228.91
|
| Rate for Payer: Galaxy Health WC |
$4,708.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3,323.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$341.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$208.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,517.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$386.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$291.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,329.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.85
|
| Rate for Payer: Multiplan Commercial |
$4,431.65
|
| Rate for Payer: Networks By Design Commercial |
$2,769.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,708.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,323.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,323.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,023.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,979.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,814.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$208.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.91
|
| Rate for Payer: Vantage Medical Group Senior |
$228.91
|
|
