|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 2930012601
|
| 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 |
$0.16
|
| 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 |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| 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 |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| 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 |
$0.09
|
| 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 |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| 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
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 5281727010
|
| 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: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| 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: 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 Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| 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
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 5281727010
|
| 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
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 5026812715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET [18288]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 5026812715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Adventist Health Commercial |
$0.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.98
|
| Rate for Payer: Cigna of CA PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$1.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1.19
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$83.05
|
| Rate for Payer: Blue Shield of California Commercial |
$42.59
|
| Rate for Payer: Blue Shield of California Commercial |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$54.76
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare All Other HMO |
$39.45
|
| Rate for Payer: United Healthcare HMO Rider |
$38.60
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [29396]
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$39.45
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare HMO Rider |
$38.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$691.84 |
| Rate for Payer: Vantage Medical Group Senior |
$51.47
|
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$691.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$691.84
|
| Rate for Payer: Blue Shield of California Commercial |
$47.05
|
| Rate for Payer: Blue Shield of California Commercial |
$47.05
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Senior |
$24.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$48.44
|
| Rate for Payer: Multiplan Commercial |
$31.79
|
| Rate for Payer: Networks By Design Commercial |
$30.27
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare All Other HMO |
$22.12
|
| Rate for Payer: United Healthcare HMO Rider |
$21.64
|
| Rate for Payer: United Healthcare HMO Rider |
$14.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.47
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
|
IP
|
$60.55
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$51.47 |
| Rate for Payer: United Healthcare HMO Rider |
$14.20
|
| Rate for Payer: United Healthcare HMO Rider |
$21.64
|
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California Commercial |
$30.56
|
| Rate for Payer: Blue Shield of California Commercial |
$30.70
|
| Rate for Payer: Blue Shield of California Commercial |
$46.56
|
| Rate for Payer: Blue Shield of California Commercial |
$20.15
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: EPIC Health Plan Senior |
$24.22
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$31.79
|
| Rate for Payer: Multiplan Commercial |
$48.44
|
| Rate for Payer: Networks By Design Commercial |
$30.27
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Other HMO |
$22.12
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.83
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
|
IP
|
$80.03
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Adventist Health Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California Commercial |
$86.39
|
| Rate for Payer: Blue Shield of California Commercial |
$40.58
|
| Rate for Payer: Blue Shield of California Commercial |
$61.54
|
| Rate for Payer: Blue Shield of California Commercial |
$56.96
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$44.94
|
| Rate for Payer: EPIC Health Plan Senior |
$32.01
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: Multiplan Commercial |
$89.87
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.04
|
| Rate for Payer: United Healthcare All Other HMO |
$29.23
|
| Rate for Payer: United Healthcare All Other HMO |
$41.04
|
| Rate for Payer: United Healthcare HMO Rider |
$40.15
|
| Rate for Payer: United Healthcare HMO Rider |
$28.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.21
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
|
OP
|
$112.34
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$691.84 |
| Rate for Payer: Adventist Health Commercial |
$22.47
|
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$691.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$691.84
|
| Rate for Payer: Blue Shield of California Commercial |
$47.05
|
| Rate for Payer: Blue Shield of California Commercial |
$47.05
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$44.94
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.02
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Multiplan Commercial |
$89.87
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.04
|
| Rate for Payer: United Healthcare All Other HMO |
$41.04
|
| Rate for Payer: United Healthcare All Other HMO |
$29.23
|
| Rate for Payer: United Healthcare HMO Rider |
$28.60
|
| Rate for Payer: United Healthcare HMO Rider |
$40.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$95.49
|
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT [208374]
|
Facility
|
OP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$6,007.99 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.42
|
| Rate for Payer: Blue Shield of California Commercial |
$176.41
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.29
|
| Rate for Payer: EPIC Health Plan Senior |
$190.19
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,696.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$5,654.58
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,240.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,240.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Vantage Medical Group Senior |
$190.19
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT [208374]
|
Facility
|
IP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,413.64 |
| Max. Negotiated Rate |
$6,007.99 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,583.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5,435.46
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,827.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2,827.29
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,170.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,696.37
|
| Rate for Payer: Multiplan Commercial |
$5,654.58
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT FOR HOME INFUSION DOCUMENTATION ORDER [4082180]
|
Facility
|
IP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,413.64 |
| Max. Negotiated Rate |
$6,007.99 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,583.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5,435.46
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,827.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2,827.29
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,170.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,696.37
|
| Rate for Payer: Multiplan Commercial |
$5,654.58
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT FOR HOME INFUSION DOCUMENTATION ORDER [4082180]
|
Facility
|
OP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$6,007.99 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.42
|
| Rate for Payer: Blue Shield of California Commercial |
$176.41
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.29
|
| Rate for Payer: EPIC Health Plan Senior |
$190.19
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,696.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$5,654.58
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,240.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,240.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Vantage Medical Group Senior |
$190.19
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$102,252.23
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$102,252.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,298.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,252.23
|
| Rate for Payer: EPIC Health Plan Senior |
$68,168.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,971.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,759.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,041.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$93,979.58
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$93,979.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,165.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,979.58
|
| Rate for Payer: EPIC Health Plan Senior |
$62,653.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,957.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,740.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,322.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BONE MARROW HARVESTING FOR TRANSPLANTATION; ALLOGENEIC
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 38230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,203.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.60
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California Commercial |
$38.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,479.25
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| Rate for Payer: Blue Shield of California Commercial |
$184.56
|
| Rate for Payer: Blue Shield of California Commercial |
$121.68
|
| Rate for Payer: Blue Shield of California Commercial |
$975.27
|
| Rate for Payer: Blue Shield of California Commercial |
$25.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$702.69
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$72.86 |
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.86
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,635.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,346.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,346.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$1,538.88
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$702.69
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$1,635.04 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$284.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.07
|
| Rate for Payer: Blue Shield of California Commercial |
$54.96
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$1,538.86
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Other HMO |
$702.68
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
