|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
|
OP
|
$1,758.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$1,494.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.74
|
| Rate for Payer: Blue Distinction Transplant |
$1,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,295.65
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna of CA HMO |
$1,230.60
|
| Rate for Payer: Cigna of CA PPO |
$1,230.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Media |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,318.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| Rate for Payer: Networks By Design Commercial |
$879.00
|
| 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: TriValley Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other HMO |
$879.00
|
| Rate for Payer: United Healthcare HMO Rider |
$879.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$879.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
|
IP
|
$1,758.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$421.92 |
| Max. Negotiated Rate |
$1,494.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1,251.70
|
| Rate for Payer: Blue Shield of California EPN |
$900.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna of CA HMO |
$1,230.60
|
| Rate for Payer: Cigna of CA PPO |
$1,230.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.92
|
| Rate for Payer: Multiplan Commercial |
$1,406.40
|
| Rate for Payer: Networks By Design Commercial |
$879.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$663.82
|
| Rate for Payer: United Healthcare All Other HMO |
$648.35
|
| Rate for Payer: United Healthcare HMO Rider |
$634.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.14
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
ERX38271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Blue Shield of California Commercial |
$158.06
|
| Rate for Payer: Blue Shield of California Commercial |
$239.40
|
| Rate for Payer: Blue Shield of California Commercial |
$312.92
|
| Rate for Payer: Blue Shield of California EPN |
$172.15
|
| Rate for Payer: Blue Shield of California EPN |
$225.02
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cigna of CA HMO |
$307.65
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: Cigna of CA PPO |
$307.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.49
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Galaxy Health WC |
$373.58
|
| Rate for Payer: Global Benefits Group Commercial |
$263.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.48
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$268.98
|
| Rate for Payer: Multiplan Commercial |
$351.60
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$219.75
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: Prime Health Services Commercial |
$373.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.83
|
| Rate for Payer: United Healthcare All Other HMO |
$124.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.87
|
| Rate for Payer: United Healthcare All Other HMO |
$162.09
|
| Rate for Payer: United Healthcare HMO Rider |
$158.57
|
| Rate for Payer: United Healthcare HMO Rider |
$80.10
|
| Rate for Payer: United Healthcare HMO Rider |
$121.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.04
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
|
OP
|
$336.23
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
ERX38271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$285.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.74
|
| Rate for Payer: Blue Distinction Transplant |
$201.74
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Distinction Transplant |
$263.70
|
| Rate for Payer: Blue Shield of California Commercial |
$163.61
|
| Rate for Payer: Blue Shield of California Commercial |
$247.80
|
| Rate for Payer: Blue Shield of California Commercial |
$323.91
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA HMO |
$307.65
|
| Rate for Payer: Cigna of CA PPO |
$307.65
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Media |
$20.15
|
| Rate for Payer: Dignity Health Media |
$20.15
|
| Rate for Payer: Dignity Health Media |
$20.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Galaxy Health WC |
$373.58
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Global Benefits Group Commercial |
$263.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$329.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$252.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Multiplan Commercial |
$268.98
|
| Rate for Payer: Multiplan Commercial |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$219.75
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Prime Health Services Commercial |
$373.58
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$263.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$263.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$219.75
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.12
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$219.75
|
| Rate for Payer: United Healthcare HMO Rider |
$168.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
1715018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: 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 9994-0802-61
|
| Hospital Charge Code |
1715018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.50 |
| 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 |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: Blue Distinction Transplant |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$2.39
|
| 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 Media |
$4.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: 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
|
| 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
|
IP
|
$140.87
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
NDG216389
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$119.74 |
| Rate for Payer: Blue Shield of California Commercial |
$100.30
|
| Rate for Payer: Blue Shield of California EPN |
$72.13
|
| Rate for Payer: Cash Price |
$63.39
|
| Rate for Payer: Cigna of CA HMO |
$98.61
|
| Rate for Payer: Cigna of CA PPO |
$98.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.35
|
| Rate for Payer: Galaxy Health WC |
$119.74
|
| Rate for Payer: Global Benefits Group Commercial |
$84.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$112.70
|
| Rate for Payer: Networks By Design Commercial |
$91.57
|
| Rate for Payer: Prime Health Services Commercial |
$119.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
|
OP
|
$140.87
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
NDG216389
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$119.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.93
|
| Rate for Payer: Blue Distinction Transplant |
$84.52
|
| Rate for Payer: Blue Shield of California Commercial |
$103.82
|
| Rate for Payer: Blue Shield of California EPN |
$82.27
|
| Rate for Payer: Cash Price |
$63.39
|
| Rate for Payer: Cigna of CA HMO |
$98.61
|
| Rate for Payer: Cigna of CA PPO |
$98.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.74
|
| Rate for Payer: Dignity Health Media |
$119.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.35
|
| Rate for Payer: Galaxy Health WC |
$119.74
|
| Rate for Payer: Global Benefits Group Commercial |
$84.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$105.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$112.70
|
| Rate for Payer: Networks By Design Commercial |
$91.57
|
| Rate for Payer: Prime Health Services Commercial |
$119.74
|
| 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 |
$70.44
|
| Rate for Payer: United Healthcare All Other HMO |
$70.44
|
| Rate for Payer: United Healthcare HMO Rider |
$70.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$119.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
1740336
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Distinction Transplant |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| 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: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
1740336
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| 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: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
OP
|
$20.24
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1711475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Blue Distinction Transplant |
$12.16
|
| Rate for Payer: Blue Distinction Transplant |
$8.84
|
| Rate for Payer: Blue Distinction Transplant |
$12.14
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California Commercial |
$10.86
|
| Rate for Payer: Blue Shield of California Commercial |
$14.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cigna of CA HMO |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$10.32
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Cigna of CA PPO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.53
|
| Rate for Payer: Dignity Health Media |
$12.53
|
| Rate for Payer: Dignity Health Media |
$17.20
|
| Rate for Payer: Dignity Health Media |
$17.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.11
|
| Rate for Payer: Galaxy Health WC |
$17.23
|
| Rate for Payer: Galaxy Health WC |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$12.53
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$16.19
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Networks By Design Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Prime Health Services Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.37
|
| Rate for Payer: United Healthcare All Other HMO |
$10.14
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$7.37
|
| Rate for Payer: United Healthcare HMO Rider |
$7.37
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$17.23
|
| Rate for Payer: Vantage Medical Group Senior |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$17.20
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
IP
|
$14.74
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1711475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$12.53 |
| Rate for Payer: Blue Shield of California Commercial |
$10.49
|
| Rate for Payer: Blue Shield of California Commercial |
$14.41
|
| Rate for Payer: Blue Shield of California Commercial |
$14.43
|
| Rate for Payer: Blue Shield of California EPN |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$10.38
|
| Rate for Payer: Blue Shield of California EPN |
$7.55
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cigna of CA HMO |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$10.32
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Cigna of CA PPO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$12.53
|
| Rate for Payer: Galaxy Health WC |
$17.23
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Global Benefits Group Commercial |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$16.19
|
| Rate for Payer: Multiplan Commercial |
$16.22
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO |
$7.46
|
| Rate for Payer: United Healthcare All Other HMO |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO |
$7.48
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$5.32
|
| Rate for Payer: United Healthcare HMO Rider |
$7.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.69
|
|
|
CYCLOSPORINE 100 MG/ML ORAL SOLUTION [9708]
|
Facility
|
OP
|
$19.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1719136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Blue Distinction Transplant |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.49
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cigna of CA HMO |
$13.76
|
| Rate for Payer: Cigna of CA PPO |
$13.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.71
|
| Rate for Payer: Dignity Health Media |
$16.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$16.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$15.73
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Other HMO |
$9.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.71
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
CYCLOSPORINE 100 MG/ML ORAL SOLUTION [9708]
|
Facility
|
IP
|
$19.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1719136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Blue Shield of California Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California EPN |
$10.07
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cigna of CA HMO |
$13.76
|
| Rate for Payer: Cigna of CA PPO |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$16.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$15.73
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.42
|
| Rate for Payer: United Healthcare All Other HMO |
$7.25
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.49
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
OP
|
$9.39
|
|
|
Service Code
|
CPT J7516
|
| Hospital Charge Code |
NDG9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.61
|
| Rate for Payer: Blue Distinction Transplant |
$5.63
|
| Rate for Payer: Blue Distinction Transplant |
$9.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$46.93
|
| Rate for Payer: Blue Shield of California EPN |
$46.93
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Media |
$7.98
|
| Rate for Payer: Dignity Health Media |
$13.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$13.41
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Networks By Design Commercial |
$4.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.98
|
| Rate for Payer: Prime Health Services Commercial |
$13.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$7.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Vantage Medical Group Senior |
$7.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13.41
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
IP
|
$15.78
|
|
|
Service Code
|
CPT J7516
|
| Hospital Charge Code |
NDG9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$13.41 |
| Rate for Payer: Blue Shield of California Commercial |
$11.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$13.41
|
| Rate for Payer: Galaxy Health WC |
$7.98
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Networks By Design Commercial |
$4.70
|
| Rate for Payer: Prime Health Services Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.55
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$5.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.10
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1711480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.55
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.31
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
OP
|
$5.07
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1711480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Distinction Transplant |
$3.07
|
| Rate for Payer: Blue Distinction Transplant |
$2.21
|
| Rate for Payer: Blue Distinction Transplant |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.55
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Media |
$3.14
|
| Rate for Payer: Dignity Health Media |
$4.31
|
| Rate for Payer: Dignity Health Media |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1712179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO |
$1.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1712179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| 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 |
$7.14
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
NDG28844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Blue Distinction Transplant |
$5.69
|
| Rate for Payer: Blue Distinction Transplant |
$8.15
|
| Rate for Payer: Blue Distinction Transplant |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California Commercial |
$10.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6.99
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$9.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.55
|
| Rate for Payer: Dignity Health Media |
$11.55
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Media |
$8.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$11.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$10.87
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$11.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
IP
|
$13.59
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
NDG28844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Global Benefits Group Commercial |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$10.87
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$7.59
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$5.01
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.42
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1712180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| 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 |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Distinction Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$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 Media |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| 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: 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 |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| 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
|
CPT J7515
|
| Hospital Charge Code |
1712180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| 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: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| 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 |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
