|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| 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: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.00
|
| 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 Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.83
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
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 100 MG CAPSULE [9706]
|
Facility
|
OP
|
$22.35
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.94
|
| Rate for Payer: EPIC Health Plan Senior |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$19.02
|
| Rate for Payer: Galaxy Health WC |
$14.41
|
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| 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: Cash Price |
$7.63
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cigna of CA HMO |
$15.64
|
| Rate for Payer: Cigna of CA HMO |
$15.67
|
| Rate for Payer: Cigna of CA HMO |
$11.87
|
| Rate for Payer: Cigna of CA PPO |
$15.67
|
| Rate for Payer: Cigna of CA PPO |
$11.87
|
| Rate for Payer: Cigna of CA PPO |
$15.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.67
|
| Rate for Payer: Global Benefits Group Commercial |
$13.41
|
| Rate for Payer: Global Benefits Group Commercial |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| 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 |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$17.88
|
| Rate for Payer: Multiplan Commercial |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Networks By Design Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$19.02
|
| Rate for Payer: Prime Health Services Commercial |
$14.41
|
| Rate for Payer: Prime Health Services Commercial |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.43
|
| 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 |
$13.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.36
|
| Rate for Payer: United Healthcare All Other HMO |
$8.18
|
| Rate for Payer: United Healthcare All Other HMO |
$8.16
|
| 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 |
$8.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.02
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$19.02
|
| Rate for Payer: Vantage Medical Group Senior |
$19.00
|
|
|
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: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$17.19
|
| Rate for Payer: Blue Shield of California Commercial |
$13.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8.59
|
| Rate for Payer: Blue Shield of California Commercial |
$17.21
|
| Rate for Payer: Blue Shield of California Commercial |
$11.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cigna of CA HMO |
$15.67
|
| Rate for Payer: Cigna of CA HMO |
$15.64
|
| 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 |
$15.67
|
| Rate for Payer: Cigna of CA PPO |
$15.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.94
|
| Rate for Payer: EPIC Health Plan Senior |
$6.78
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.02
|
| Rate for Payer: Galaxy Health WC |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$19.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13.41
|
| Rate for Payer: Global Benefits Group Commercial |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$13.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: Multiplan Commercial |
$17.88
|
| Rate for Payer: Multiplan Commercial |
$17.90
|
| Rate for Payer: Networks By Design Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| 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 |
$19.00
|
| Rate for Payer: Prime Health Services Commercial |
$19.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.18
|
| Rate for Payer: United Healthcare All Other HMO |
$6.19
|
| Rate for Payer: United Healthcare All Other HMO |
$8.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7.99
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.32
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
OP
|
$17.43
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$449.11 |
| Rate for Payer: Networks By Design Commercial |
$8.71
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.05
|
| Rate for Payer: Blue Shield of California Commercial |
$82.09
|
| Rate for Payer: Blue Shield of California Commercial |
$82.09
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna of CA HMO |
$12.20
|
| Rate for Payer: Cigna of CA HMO |
$12.19
|
| Rate for Payer: Cigna of CA PPO |
$12.19
|
| Rate for Payer: Cigna of CA PPO |
$12.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.97
|
| Rate for Payer: Galaxy Health WC |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$14.81
|
| Rate for Payer: Global Benefits Group Commercial |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$10.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.19
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: Networks By Design Commercial |
$8.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.81
|
| Rate for Payer: Prime Health Services Commercial |
$14.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.36
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6.23
|
| Rate for Payer: United Healthcare HMO Rider |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.82
|
| Rate for Payer: Vantage Medical Group Senior |
$14.81
|
| Rate for Payer: Vantage Medical Group Senior |
$14.82
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
IP
|
$17.43
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: EPIC Health Plan Senior |
$6.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.97
|
| Rate for Payer: Galaxy Health WC |
$14.81
|
| Rate for Payer: Galaxy Health WC |
$14.82
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.83
|
| Rate for Payer: Blue Shield of California Commercial |
$13.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna of CA HMO |
$12.20
|
| Rate for Payer: Cigna of CA HMO |
$12.19
|
| Rate for Payer: Cigna of CA PPO |
$12.19
|
| Rate for Payer: Cigna of CA PPO |
$12.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: Global Benefits Group Commercial |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.18
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: Networks By Design Commercial |
$8.71
|
| Rate for Payer: Networks By Design Commercial |
$8.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO |
$6.36
|
| Rate for Payer: United Healthcare HMO Rider |
$6.23
|
| Rate for Payer: United Healthcare HMO Rider |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.71
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.12
|
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$2.98
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.61
|
| Rate for Payer: Prime Health Services Commercial |
$4.89
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.85
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.52
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$2.98
|
| Rate for Payer: Cigna of CA HMO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$4.03
|
| Rate for Payer: Cigna of CA PPO |
$2.98
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.70
|
| Rate for Payer: Galaxy Health WC |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Global Benefits Group Commercial |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.80
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$2.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$4.89
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Prime Health Services Commercial |
$3.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.89
|
| 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 Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.89
|
| Rate for Payer: Vantage Medical Group Senior |
$3.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$3.70
|
| Rate for Payer: Galaxy Health WC |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$7.41
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$3.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: United Healthcare HMO Rider |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| 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 Commercial |
$5.28
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.87
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$10.98
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$10.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$13.34
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$3.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.73
|
| Rate for Payer: United Healthcare HMO Rider |
$5.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.14
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
OP
|
$15.69
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| 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: Cash Price |
$4.71
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO |
$10.98
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$7.32
|
| Rate for Payer: Cigna of CA PPO |
$10.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.18
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$8.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$8.37
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$7.84
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$13.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$5.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.82
|
| Rate for Payer: United Healthcare HMO Rider |
$3.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$5.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$13.34
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Senior |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.48
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 5074219001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 5026818911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 5074219001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 5026818911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 5026818915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 5026818915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Adventist Health Commercial |
$2.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.32
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.70
|
| Rate for Payer: Cigna of CA PPO |
$8.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.57
|
| Rate for Payer: Global Benefits Group Commercial |
$7.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.70
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.57
|
| Rate for Payer: Vantage Medical Group Senior |
$10.57
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Adventist Health Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.70
|
| Rate for Payer: Cigna of CA PPO |
$8.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.57
|
| Rate for Payer: Global Benefits Group Commercial |
$7.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$62,766.69
|
|
|
Service Code
|
APR-DRG 1314
|
| Min. Negotiated Rate |
$50,130.76 |
| Max. Negotiated Rate |
$62,766.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50,130.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62,766.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,159.67
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$32,145.87
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$25,674.40 |
| Max. Negotiated Rate |
$32,145.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,674.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,145.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,762.10
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$45,053.71
|
|
|
Service Code
|
APR-DRG 1313
|
| Min. Negotiated Rate |
$35,983.69 |
| Max. Negotiated Rate |
$45,053.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,983.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,053.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,311.22
|
|
