|
CYCLOPENTOLATE 1 % EYE DROPS >2 ML [4082025]
|
Facility
|
IP
|
$2.24
|
|
|
Service Code
|
NDC 6131439603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]
|
Facility
|
OP
|
$22.21
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Vantage Medical Group Senior |
$18.88
|
| Rate for Payer: Adventist Health Commercial |
$4.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.66
|
| Rate for Payer: Cash Price |
$9.99
|
| Rate for Payer: Cigna of CA HMO |
$15.55
|
| Rate for Payer: Cigna of CA PPO |
$15.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.88
|
| Rate for Payer: EPIC Health Plan Senior |
$8.88
|
| Rate for Payer: Galaxy Health WC |
$18.88
|
| Rate for Payer: Global Benefits Group Commercial |
$13.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.55
|
| Rate for Payer: Multiplan Commercial |
$17.77
|
| Rate for Payer: Networks By Design Commercial |
$11.11
|
| Rate for Payer: Prime Health Services Commercial |
$18.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.34
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$7.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.88
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]
|
Facility
|
IP
|
$22.21
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Adventist Health Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California Commercial |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$17.08
|
| Rate for Payer: Cash Price |
$9.99
|
| Rate for Payer: Cigna of CA HMO |
$15.55
|
| Rate for Payer: Cigna of CA PPO |
$15.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.88
|
| Rate for Payer: EPIC Health Plan Senior |
$8.88
|
| Rate for Payer: Galaxy Health WC |
$18.88
|
| Rate for Payer: Global Benefits Group Commercial |
$13.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.33
|
| Rate for Payer: Multiplan Commercial |
$17.77
|
| Rate for Payer: Networks By Design Commercial |
$11.11
|
| Rate for Payer: Prime Health Services Commercial |
$18.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.34
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$7.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.27
|
|
|
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 |
$340.92
|
| Rate for Payer: Blue Shield of California Commercial |
$517.10
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$426.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.73
|
| 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 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
|
OP
|
$672.43
|
|
|
Service Code
|
HCPCS J9074
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$571.57 |
| Rate for Payer: Adventist Health Commercial |
$134.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$470.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$571.57
|
| Rate for Payer: Global Benefits Group Commercial |
$403.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$426.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.61
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$403.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.46
|
| 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
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
|
IP
|
$283.20
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Cigna of CA HMO |
$198.24
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$212.52
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$198.24
|
| Rate for Payer: Adventist Health Commercial |
$56.64
|
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$60.72
|
| Rate for Payer: Blue Shield of California Commercial |
$233.47
|
| Rate for Payer: Blue Shield of California Commercial |
$106.47
|
| Rate for Payer: Blue Shield of California Commercial |
$219.02
|
| Rate for Payer: Blue Shield of California Commercial |
$217.78
|
| Rate for Payer: Blue Shield of California Commercial |
$143.58
|
| Rate for Payer: Blue Shield of California Commercial |
$161.49
|
| Rate for Payer: Blue Shield of California Commercial |
$153.93
|
| Rate for Payer: Blue Shield of California Commercial |
$332.21
|
| Rate for Payer: Cash Price |
$127.44
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cigna of CA HMO |
$212.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$113.28
|
| Rate for Payer: EPIC Health Plan Senior |
$121.44
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$258.06
|
| Rate for Payer: Galaxy Health WC |
$240.72
|
| Rate for Payer: Global Benefits Group Commercial |
$182.16
|
| Rate for Payer: Global Benefits Group Commercial |
$169.92
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$151.80
|
| Rate for Payer: Networks By Design Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$258.06
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Prime Health Services Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$103.45
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare All Other HMO |
$110.91
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$101.22
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare HMO Rider |
$108.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.43
|
|
|
CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
|
OP
|
$283.20
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Adventist Health Commercial |
$56.64
|
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$60.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| 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 Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$127.44
|
| Rate for Payer: Cash Price |
$127.44
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$198.24
|
| Rate for Payer: Cigna of CA HMO |
$212.52
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$198.24
|
| Rate for Payer: Cigna of CA PPO |
$212.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$302.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$258.06
|
| Rate for Payer: Galaxy Health WC |
$240.72
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$169.92
|
| Rate for Payer: Global Benefits Group Commercial |
$182.16
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$226.56
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$151.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Prime Health Services Commercial |
$240.72
|
| Rate for Payer: Prime Health Services Commercial |
$258.06
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$103.45
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare All Other HMO |
$110.91
|
| Rate for Payer: United Healthcare HMO Rider |
$108.51
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare HMO Rider |
$101.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
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: Cigna of CA PPO |
$123.06
|
| Rate for Payer: Cigna of CA HMO |
$123.06
|
| Rate for Payer: Adventist Health Commercial |
$35.16
|
| Rate for Payer: Blue Shield of California Commercial |
$135.19
|
| Rate for Payer: Blue Shield of California Commercial |
$89.13
|
| Rate for Payer: Cash Price |
$79.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$111.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.72
|
| 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 |
$0.58 |
| Max. Negotiated Rate |
$149.43 |
| Rate for Payer: Adventist Health Commercial |
$35.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$79.11
|
| Rate for Payer: Cash Price |
$79.11
|
| 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 |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$149.43
|
| Rate for Payer: Global Benefits Group Commercial |
$105.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| 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 |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
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: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| 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
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J8530
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| 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 |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| 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 |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| 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 |
$1.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| 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
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$377.40 |
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| 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: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Adventist Health Commercial |
$351.60
|
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| 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 Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$244.08
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA HMO |
$1,230.60
|
| Rate for Payer: Cigna of CA HMO |
$310.80
|
| Rate for Payer: Cigna of CA HMO |
$379.68
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$1,230.60
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Cigna of CA PPO |
$379.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,230.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Global Benefits Group Commercial |
$325.44
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,116.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| 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: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| 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 |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$271.20
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| 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 |
$1,494.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.44
|
| 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 |
$1,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.78
|
| Rate for Payer: United Healthcare All Other HMO |
$162.19
|
| Rate for Payer: United Healthcare All Other HMO |
$642.20
|
| 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 |
$628.31
|
| 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 |
$575.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
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: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Adventist Health Commercial |
$351.60
|
| Rate for Payer: Adventist Health Commercial |
$108.48
|
| Rate for Payer: Blue Shield of California Commercial |
$417.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,351.90
|
| Rate for Payer: Blue Shield of California Commercial |
$438.05
|
| Rate for Payer: Blue Shield of California Commercial |
$341.44
|
| Rate for Payer: Blue Shield of California Commercial |
$225.11
|
| Rate for Payer: Blue Shield of California Commercial |
$891.31
|
| Rate for Payer: Blue Shield of California Commercial |
$275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$664.42
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$244.08
|
| 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 |
$1,230.60
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$379.68
|
| Rate for Payer: Cigna of CA PPO |
$1,230.60
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,230.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$703.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$216.96
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Galaxy Health WC |
$461.04
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Global Benefits Group Commercial |
$325.44
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,116.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,037.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$261.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$320.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$509.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| 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 |
$1,406.40
|
| Rate for Payer: Multiplan Commercial |
$433.92
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| 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: Networks By Design Commercial |
$879.00
|
| Rate for Payer: Prime Health Services Commercial |
$461.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| 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 |
$659.78
|
| 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 All Other HMO |
$642.20
|
| Rate for Payer: United Healthcare HMO Rider |
$158.69
|
| Rate for Payer: United Healthcare HMO Rider |
$628.31
|
| Rate for Payer: United Healthcare HMO Rider |
$308.79
|
| Rate for Payer: United Healthcare HMO Rider |
$193.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.64
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
|
IP
|
$1,344.88
|
|
|
Service Code
|
HCPCS J9074
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.98 |
| Max. Negotiated Rate |
$1,143.15 |
| Rate for Payer: Adventist Health Commercial |
$268.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,034.21
|
| Rate for Payer: Blue Shield of California Commercial |
$681.85
|
| Rate for Payer: Cash Price |
$605.20
|
| Rate for Payer: Cigna of CA HMO |
$941.42
|
| Rate for Payer: Cigna of CA PPO |
$941.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$941.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.95
|
| Rate for Payer: EPIC Health Plan Senior |
$537.95
|
| Rate for Payer: Galaxy Health WC |
$1,143.15
|
| Rate for Payer: Global Benefits Group Commercial |
$806.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.77
|
| Rate for Payer: Multiplan Commercial |
$1,075.90
|
| Rate for Payer: Networks By Design Commercial |
$672.44
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.73
|
| Rate for Payer: United Healthcare All Other HMO |
$491.28
|
| Rate for Payer: United Healthcare HMO Rider |
$480.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.45
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
|
OP
|
$1,344.88
|
|
|
Service Code
|
HCPCS J9074
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$1,143.15 |
| Rate for Payer: United Healthcare HMO Rider |
$480.66
|
| Rate for Payer: Adventist Health Commercial |
$268.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$605.20
|
| Rate for Payer: Cash Price |
$605.20
|
| Rate for Payer: Cigna of CA HMO |
$941.42
|
| Rate for Payer: Cigna of CA PPO |
$941.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$941.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$1,143.15
|
| Rate for Payer: Global Benefits Group Commercial |
$806.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$1,075.90
|
| Rate for Payer: Networks By Design Commercial |
$672.44
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$806.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$806.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.73
|
| Rate for Payer: United Healthcare All Other HMO |
$491.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS J9075
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$120.36
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Adventist Health Commercial |
$28.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: Cash Price |
$97.20
|
| 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 |
$151.20
|
| Rate for Payer: Cigna of CA PPO |
$99.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$84.96
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.81
|
| 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 |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.78
|
| 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 |
$0.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
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 |
$3.44 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Upland Medical Group Pediatric |
$3.44
|
| Rate for Payer: Adventist Health Commercial |
$67.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cash Price |
$151.30
|
| 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 |
$4.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.61
|
| 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: Vantage Medical Group Commercial/Exchange |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3.78
|
|
|
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 |
$71.79
|
| Rate for Payer: Blue Shield of California Commercial |
$109.51
|
| Rate for Payer: Blue Shield of California Commercial |
$166.10
|
| Rate for Payer: Blue Shield of California Commercial |
$108.89
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: Cash Price |
$97.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 |
$129.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| 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 |
$170.47
|
| Rate for Payer: Blue Shield of California Commercial |
$258.56
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$213.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.38
|
| 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
|
IP
|
$5.30
|
|
|
Service Code
|
NDC 9994080261
|
| 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 |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.13
|
| 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
|
|
|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
|
OP
|
$5.30
|
|
|
Service Code
|
NDC 9994080261
|
| 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 |
$3.40
|
| Rate for Payer: Cash Price |
$2.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.13
|
| 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
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
|
OP
|
$140.86
|
|
|
Service Code
|
NDC 0023530105
|
| 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: 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 |
$90.39
|
| Rate for Payer: Cash Price |
$63.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.11
|
| 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: Multiplan Commercial |
$112.69
|
| Rate for Payer: Networks By Design Commercial |
$91.56
|
| 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 0023530105
|
| 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 |
$108.32
|
| Rate for Payer: Blue Shield of California Commercial |
$71.42
|
| Rate for Payer: Cash Price |
$63.39
|
| Rate for Payer: Cigna of CA HMO |
$98.60
|
| Rate for Payer: Cigna of CA PPO |
$98.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.11
|
| 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
|
$1.18
|
|
|
Service Code
|
NDC 7304300501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Senior |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Networks By Design Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
NDC 6050562021
|
| 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 |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.30
|
| 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
|
|
