|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 72266-146-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 72485-508-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
NDC 55150-221-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 72485-508-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 0143-9506-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$0.49
|
| Rate for Payer: Prime Health Services Commercial |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: Vantage Medical Group Senior |
$0.64
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 72485-508-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
OP
|
$103.86
|
|
|
Service Code
|
HCPCS J8560
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$204.64 |
| Rate for Payer: Adventist Health Commercial |
$20.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.64
|
| Rate for Payer: Blue Shield of California Commercial |
$90.40
|
| Rate for Payer: Blue Shield of California EPN |
$90.40
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna of CA HMO |
$72.70
|
| Rate for Payer: Cigna of CA PPO |
$72.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.54
|
| Rate for Payer: EPIC Health Plan Senior |
$41.54
|
| Rate for Payer: Galaxy Health WC |
$88.28
|
| Rate for Payer: Global Benefits Group Commercial |
$62.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.70
|
| Rate for Payer: Multiplan Commercial |
$83.09
|
| Rate for Payer: Networks By Design Commercial |
$51.93
|
| Rate for Payer: Prime Health Services Commercial |
$88.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.98
|
| Rate for Payer: United Healthcare All Other HMO |
$37.94
|
| Rate for Payer: United Healthcare HMO Rider |
$37.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.28
|
| Rate for Payer: Vantage Medical Group Senior |
$88.28
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
IP
|
$103.86
|
|
|
Service Code
|
HCPCS J8560
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$88.28 |
| Rate for Payer: Adventist Health Commercial |
$20.77
|
| Rate for Payer: Blue Shield of California Commercial |
$76.65
|
| Rate for Payer: Blue Shield of California EPN |
$50.48
|
| Rate for Payer: Cash Price |
$57.13
|
| Rate for Payer: Cigna of CA HMO |
$72.70
|
| Rate for Payer: Cigna of CA PPO |
$72.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.54
|
| Rate for Payer: EPIC Health Plan Senior |
$41.54
|
| Rate for Payer: Galaxy Health WC |
$88.28
|
| Rate for Payer: Global Benefits Group Commercial |
$62.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.93
|
| Rate for Payer: Multiplan Commercial |
$83.09
|
| Rate for Payer: Networks By Design Commercial |
$51.93
|
| Rate for Payer: Prime Health Services Commercial |
$88.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.98
|
| Rate for Payer: United Healthcare All Other HMO |
$37.94
|
| Rate for Payer: United Healthcare HMO Rider |
$37.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.01
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
OP
|
$14.98
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.20
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$11.98
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$12.73
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
IP
|
$14.98
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California EPN |
$7.28
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$11.98
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$22.11
|
| Rate for Payer: Blue Shield of California EPN |
$14.56
|
| Rate for Payer: Cash Price |
$16.48
|
| Rate for Payer: Cigna of CA HMO |
$20.97
|
| Rate for Payer: Cigna of CA PPO |
$20.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Multiplan Commercial |
$23.97
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.40
|
| Rate for Payer: Cash Price |
$16.48
|
| Rate for Payer: Cigna of CA HMO |
$20.97
|
| Rate for Payer: Cigna of CA PPO |
$20.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$23.97
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.98
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.47
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
EUCALYPTUS OIL-ALOE EXTR-LAVENDER,ROSEMARY OIL-PETROLATUM TOP OINTMENT [9125]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 2390000617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
EUCALYPTUS OIL-ALOE EXTR-LAVENDER,ROSEMARY OIL-PETROLATUM TOP OINTMENT [9125]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 2390000617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.66
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.59
|
| Rate for Payer: Vantage Medical Group Senior |
$33.59
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California Commercial |
$29.17
|
| Rate for Payer: Blue Shield of California EPN |
$19.21
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Cigna of CA PPO |
$9.21
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$11.19
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$7.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$6.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Prime Health Services Commercial |
$11.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA HMO |
$9.21
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$11.32 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Adventist Health Commercial |
$2.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA HMO |
$9.21
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$9.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$11.19
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Networks By Design Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$6.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.91
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$11.19
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
OP
|
$26.36
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$22.41 |
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$18.42
|
| Rate for Payer: Cigna of CA HMO |
$18.45
|
| Rate for Payer: Cigna of CA PPO |
$18.42
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.54
|
| Rate for Payer: EPIC Health Plan Senior |
$10.54
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$10.53
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$22.37
|
| Rate for Payer: Galaxy Health WC |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.42
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$21.06
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$13.18
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$22.41
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Commercial |
$22.37
|
| Rate for Payer: Adventist Health Commercial |
$5.27
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other HMO |
$9.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9.61
|
| Rate for Payer: United Healthcare All Other HMO |
$6.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare HMO Rider |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$22.37
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
IP
|
$26.32
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$22.37 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Adventist Health Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California Commercial |
$14.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California Commercial |
$19.45
|
| Rate for Payer: Blue Shield of California Commercial |
$19.42
|
| Rate for Payer: Blue Shield of California EPN |
$9.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.79
|
| Rate for Payer: Blue Shield of California EPN |
$12.81
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$14.47
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA HMO |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$18.42
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Cigna of CA PPO |
$18.45
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$18.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$10.54
|
| Rate for Payer: EPIC Health Plan Senior |
$10.53
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$22.37
|
| Rate for Payer: Galaxy Health WC |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Global Benefits Group Commercial |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$15.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$7.87
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$13.18
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$22.41
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Commercial |
$22.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$9.61
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9.63
|
| Rate for Payer: United Healthcare All Other HMO |
$6.95
|
| Rate for Payer: United Healthcare HMO Rider |
$9.41
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$9.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.63
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
OP
|
$39.52
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Adventist Health Commercial |
$7.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cigna of CA HMO |
$27.66
|
| Rate for Payer: Cigna of CA PPO |
$27.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.81
|
| Rate for Payer: EPIC Health Plan Senior |
$15.81
|
| Rate for Payer: Galaxy Health WC |
$33.59
|
| Rate for Payer: Global Benefits Group Commercial |
$23.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.66
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Networks By Design Commercial |
$19.76
|
| Rate for Payer: Prime Health Services Commercial |
$33.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.59
|
| Rate for Payer: Vantage Medical Group Senior |
$33.59
|
|
