|
CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
|
IP
|
$672.43
|
|
|
Service Code
|
HCPCS J9074
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.49 |
| Max. Negotiated Rate |
$571.57 |
| Rate for Payer: Adventist Health Commercial |
$134.49
|
| Rate for Payer: Blue Shield of California Commercial |
$496.25
|
| Rate for Payer: Blue Shield of California EPN |
$326.80
|
| Rate for Payer: Cash Price |
$369.84
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.97
|
| Rate for Payer: EPIC Health Plan Senior |
$268.97
|
| Rate for Payer: Galaxy Health WC |
$571.57
|
| Rate for Payer: Global Benefits Group Commercial |
$403.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.38
|
| Rate for Payer: Multiplan Commercial |
$537.94
|
| Rate for Payer: Networks By Design Commercial |
$336.21
|
| Rate for Payer: Prime Health Services Commercial |
$571.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.36
|
| Rate for Payer: United Healthcare All Other HMO |
$245.64
|
| Rate for Payer: United Healthcare HMO Rider |
$240.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.22
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION [228986]
|
Facility
|
IP
|
$175.80
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$149.43 |
| Rate for Payer: Adventist Health Commercial |
$35.16
|
| Rate for Payer: Blue Shield of California Commercial |
$129.74
|
| Rate for Payer: Blue Shield of California EPN |
$85.44
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Cigna of CA HMO |
$123.06
|
| Rate for Payer: Cigna of CA PPO |
$123.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.32
|
| Rate for Payer: EPIC Health Plan Senior |
$70.32
|
| Rate for Payer: Galaxy Health WC |
$149.43
|
| Rate for Payer: Global Benefits Group Commercial |
$105.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.19
|
| Rate for Payer: Multiplan Commercial |
$140.64
|
| Rate for Payer: Networks By Design Commercial |
$87.90
|
| Rate for Payer: Prime Health Services Commercial |
$149.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.98
|
| Rate for Payer: United Healthcare All Other HMO |
$64.22
|
| Rate for Payer: United Healthcare HMO Rider |
$62.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.57
|
|
|
CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION [228986]
|
Facility
|
OP
|
$175.80
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$149.43 |
| Rate for Payer: Adventist Health Commercial |
$35.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Cigna of CA HMO |
$123.06
|
| Rate for Payer: Cigna of CA PPO |
$123.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$149.43
|
| Rate for Payer: Global Benefits Group Commercial |
$105.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$140.64
|
| Rate for Payer: Networks By Design Commercial |
$87.90
|
| Rate for Payer: Prime Health Services Commercial |
$149.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.98
|
| Rate for Payer: United Healthcare All Other HMO |
$64.22
|
| Rate for Payer: United Healthcare HMO Rider |
$62.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Cash Price |
$3.30
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: Multiplan Commercial |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$222.00
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Prime Health Services Commercial |
$461.04
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare All Other HMO |
$162.19
|
| Rate for Payer: United Healthcare All Other HMO |
$198.14
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare HMO Rider |
$158.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.64
|
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.29
|
| Rate for Payer: Blue Shield of California Commercial |
$637.63
|
| Rate for Payer: Blue Shield of California Commercial |
$327.67
|
| Rate for Payer: Blue Shield of California EPN |
$263.61
|
| Rate for Payer: Blue Shield of California EPN |
$215.78
|
| Rate for Payer: Blue Shield of California EPN |
$419.90
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$379.68
|
| Rate for Payer: Cigna of CA HMO |
$310.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$379.68
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$216.96
|
| Rate for Payer: Galaxy Health WC |
$461.04
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Global Benefits Group Commercial |
$325.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$274.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$566.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$379.68
|
| Rate for Payer: Cigna of CA HMO |
$310.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Cigna of CA PPO |
$379.68
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Galaxy Health WC |
$461.04
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Global Benefits Group Commercial |
$325.44
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$432.00
|
| Rate for Payer: Prime Health Services Commercial |
$461.04
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other HMO |
$162.19
|
| Rate for Payer: United Healthcare All Other HMO |
$315.62
|
| Rate for Payer: United Healthcare All Other HMO |
$198.14
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare HMO Rider |
$158.69
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
OP
|
$336.23
|
|
|
Service Code
|
HCPCS J9074
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Adventist Health Commercial |
$67.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Cash Price |
$184.93
|
| Rate for Payer: Cash Price |
$184.93
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.21
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$268.98
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.19
|
| Rate for Payer: United Healthcare All Other HMO |
$122.82
|
| Rate for Payer: United Healthcare HMO Rider |
$120.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
OP
|
$141.60
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$120.36 |
| Rate for Payer: Adventist Health Commercial |
$28.32
|
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$77.88
|
| Rate for Payer: Cash Price |
$77.88
|
| Rate for Payer: Cigna of CA HMO |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$99.12
|
| Rate for Payer: Cigna of CA PPO |
$99.12
|
| Rate for Payer: Cigna of CA PPO |
$151.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$120.36
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$113.28
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Networks By Design Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$70.80
|
| Rate for Payer: Prime Health Services Commercial |
$120.36
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.14
|
| Rate for Payer: United Healthcare All Other HMO |
$51.73
|
| Rate for Payer: United Healthcare All Other HMO |
$78.90
|
| Rate for Payer: United Healthcare HMO Rider |
$50.61
|
| Rate for Payer: United Healthcare HMO Rider |
$77.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Adventist Health Commercial |
$28.32
|
| Rate for Payer: Blue Shield of California Commercial |
$159.41
|
| Rate for Payer: Blue Shield of California Commercial |
$104.50
|
| Rate for Payer: Blue Shield of California EPN |
$68.82
|
| Rate for Payer: Blue Shield of California EPN |
$104.98
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$77.88
|
| Rate for Payer: Cigna of CA HMO |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$99.12
|
| Rate for Payer: Cigna of CA PPO |
$99.12
|
| Rate for Payer: Cigna of CA PPO |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.64
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$120.36
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.96
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Multiplan Commercial |
$113.28
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Networks By Design Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$70.80
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Prime Health Services Commercial |
$120.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$78.90
|
| Rate for Payer: United Healthcare All Other HMO |
$51.73
|
| Rate for Payer: United Healthcare HMO Rider |
$50.61
|
| Rate for Payer: United Healthcare HMO Rider |
$77.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.74
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
IP
|
$336.23
|
|
|
Service Code
|
HCPCS J9074
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.25 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Adventist Health Commercial |
$67.25
|
| Rate for Payer: Blue Shield of California Commercial |
$248.14
|
| Rate for Payer: Blue Shield of California EPN |
$163.41
|
| Rate for Payer: Cash Price |
$184.93
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.49
|
| Rate for Payer: EPIC Health Plan Senior |
$134.49
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.70
|
| Rate for Payer: Multiplan Commercial |
$268.98
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.19
|
| Rate for Payer: United Healthcare All Other HMO |
$122.82
|
| Rate for Payer: United Healthcare HMO Rider |
$120.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.12
|
|
|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
|
OP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.25
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Senior |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.65
|
| Rate for Payer: United Healthcare All Other HMO |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.50
|
|
|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Senior |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.50
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
|
OP
|
$140.86
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$119.73 |
| Rate for Payer: Multiplan Commercial |
$112.69
|
| Rate for Payer: Networks By Design Commercial |
$91.56
|
| Rate for Payer: Adventist Health Commercial |
$28.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.50
|
| Rate for Payer: Cash Price |
$77.48
|
| Rate for Payer: Cigna of CA HMO |
$98.60
|
| Rate for Payer: Cigna of CA PPO |
$98.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.34
|
| Rate for Payer: EPIC Health Plan Senior |
$56.34
|
| Rate for Payer: Galaxy Health WC |
$119.73
|
| Rate for Payer: Global Benefits Group Commercial |
$84.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.60
|
| Rate for Payer: Prime Health Services Commercial |
$119.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.43
|
| Rate for Payer: United Healthcare HMO Rider |
$70.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.73
|
| Rate for Payer: Vantage Medical Group Senior |
$119.73
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
|
IP
|
$140.86
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$119.73 |
| Rate for Payer: Adventist Health Commercial |
$28.17
|
| Rate for Payer: Blue Shield of California Commercial |
$103.95
|
| Rate for Payer: Blue Shield of California EPN |
$68.46
|
| Rate for Payer: Cash Price |
$77.48
|
| Rate for Payer: Cigna of CA HMO |
$98.60
|
| Rate for Payer: Cigna of CA PPO |
$98.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.34
|
| Rate for Payer: EPIC Health Plan Senior |
$56.34
|
| Rate for Payer: Galaxy Health WC |
$119.73
|
| Rate for Payer: Global Benefits Group Commercial |
$84.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$112.69
|
| Rate for Payer: Networks By Design Commercial |
$91.56
|
| Rate for Payer: Prime Health Services Commercial |
$119.73
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 68180-214-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$2.25
|
| Rate for Payer: Cigna of CA PPO |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.09
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.44
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 73043-005-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$2.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.49
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$3.22
|
|
|
Service Code
|
NDC 68180-214-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$2.25
|
| Rate for Payer: Cigna of CA PPO |
$2.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.09
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.61
|
| Rate for Payer: United Healthcare All Other HMO |
$1.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Vantage Medical Group Senior |
$2.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
NDC 73043-005-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$2.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$3.26
|
| Rate for Payer: Global Benefits Group Commercial |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$3.06
|
| Rate for Payer: Networks By Design Commercial |
$2.49
|
| Rate for Payer: Prime Health Services Commercial |
$3.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.26
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
IP
|
$16.95
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: United Healthcare HMO Rider |
$7.83
|
| Rate for Payer: United Healthcare HMO Rider |
$7.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.18
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Blue Shield of California Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California Commercial |
$16.19
|
| Rate for Payer: Blue Shield of California Commercial |
$12.51
|
| Rate for Payer: Blue Shield of California EPN |
$10.65
|
| Rate for Payer: Blue Shield of California EPN |
$8.24
|
| Rate for Payer: Blue Shield of California EPN |
$10.66
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$15.34
|
| Rate for Payer: Cigna of CA HMO |
$11.87
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$15.34
|
| Rate for Payer: Cigna of CA PPO |
$11.87
|
| Rate for Payer: Cigna of CA PPO |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.78
|
| Rate for Payer: EPIC Health Plan Senior |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.62
|
| Rate for Payer: Galaxy Health WC |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$18.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: Multiplan Commercial |
$17.53
|
| Rate for Payer: Multiplan Commercial |
$17.55
|
| Rate for Payer: Networks By Design Commercial |
$10.96
|
| Rate for Payer: Networks By Design Commercial |
$10.97
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$14.41
|
| Rate for Payer: Prime Health Services Commercial |
$18.62
|
| Rate for Payer: Prime Health Services Commercial |
$18.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.23
|
| Rate for Payer: United Healthcare All Other HMO |
$8.01
|
| Rate for Payer: United Healthcare All Other HMO |
$6.19
|
| Rate for Payer: United Healthcare All Other HMO |
$8.00
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
OP
|
$21.91
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.95
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA HMO |
$15.34
|
| Rate for Payer: Cigna of CA HMO |
$11.87
|
| Rate for Payer: Cigna of CA PPO |
$11.87
|
| Rate for Payer: Cigna of CA PPO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$15.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Senior |
$8.76
|
| Rate for Payer: EPIC Health Plan Senior |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.78
|
| Rate for Payer: Galaxy Health WC |
$18.62
|
| Rate for Payer: Galaxy Health WC |
$18.65
|
| Rate for Payer: Galaxy Health WC |
$14.41
|
| Rate for Payer: Global Benefits Group Commercial |
$13.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$17.53
|
| Rate for Payer: Multiplan Commercial |
$17.55
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$10.97
|
| Rate for Payer: Networks By Design Commercial |
$10.96
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$18.65
|
| Rate for Payer: Prime Health Services Commercial |
$14.41
|
| Rate for Payer: Prime Health Services Commercial |
$18.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.36
|
| Rate for Payer: United Healthcare All Other HMO |
$8.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$7.84
|
| Rate for Payer: United Healthcare HMO Rider |
$7.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.65
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$18.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.62
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
OP
|
$17.09
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$189.54 |
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.54
|
| Rate for Payer: Blue Shield of California Commercial |
$82.09
|
| Rate for Payer: Blue Shield of California Commercial |
$82.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.09
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$11.96
|
| Rate for Payer: Cigna of CA HMO |
$11.96
|
| Rate for Payer: Cigna of CA PPO |
$11.96
|
| Rate for Payer: Cigna of CA PPO |
$11.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: EPIC Health Plan Senior |
$6.83
|
| Rate for Payer: EPIC Health Plan Senior |
$6.84
|
| Rate for Payer: Galaxy Health WC |
$14.53
|
| Rate for Payer: Galaxy Health WC |
$14.52
|
| Rate for Payer: Global Benefits Group Commercial |
$10.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.96
|
| Rate for Payer: Multiplan Commercial |
$13.67
|
| Rate for Payer: Multiplan Commercial |
$13.66
|
| Rate for Payer: Networks By Design Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$8.54
|
| Rate for Payer: Prime Health Services Commercial |
$14.52
|
| Rate for Payer: Prime Health Services Commercial |
$14.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare HMO Rider |
$6.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.52
|
| Rate for Payer: Vantage Medical Group Senior |
$14.53
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$14.53 |
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$12.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.31
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$11.96
|
| Rate for Payer: Cigna of CA HMO |
$11.96
|
| Rate for Payer: Cigna of CA PPO |
$11.96
|
| Rate for Payer: Cigna of CA PPO |
$11.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.84
|
| Rate for Payer: EPIC Health Plan Senior |
$6.83
|
| Rate for Payer: EPIC Health Plan Senior |
$6.84
|
| Rate for Payer: Galaxy Health WC |
$14.52
|
| Rate for Payer: Galaxy Health WC |
$14.53
|
| Rate for Payer: Global Benefits Group Commercial |
$10.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$13.66
|
| Rate for Payer: Multiplan Commercial |
$13.67
|
| Rate for Payer: Networks By Design Commercial |
$8.54
|
| Rate for Payer: Networks By Design Commercial |
$8.54
|
| Rate for Payer: Prime Health Services Commercial |
$14.53
|
| Rate for Payer: Prime Health Services Commercial |
$14.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.41
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6.10
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.60
|
|
