|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 43547-399-10
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 69097-845-07
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68084-753-95
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
OP
|
$2.24
|
|
|
Service Code
|
NDC 61314-396-03
|
| Hospital Charge Code |
1740075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
OP
|
$7.17
|
|
|
Service Code
|
NDC 61314-396-01
|
| Hospital Charge Code |
1740068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
| Rate for Payer: BCBS Transplant Transplant |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.19
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna of CA HMO |
$5.02
|
| Rate for Payer: Cigna of CA PPO |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.09
|
| Rate for Payer: Dignity Health Media |
$6.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.74
|
| Rate for Payer: Networks By Design Commercial |
$4.66
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.09
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
NDC 61314-396-03
|
| Hospital Charge Code |
1740075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
IP
|
$7.17
|
|
|
Service Code
|
NDC 61314-396-01
|
| Hospital Charge Code |
1740068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Blue Shield of California Commercial |
$5.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.67
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna of CA HMO |
$5.02
|
| Rate for Payer: Cigna of CA PPO |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.74
|
| Rate for Payer: Networks By Design Commercial |
$4.66
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]
|
Facility
IP
|
$19.96
|
|
|
Service Code
|
NDC 0065-0359-02
|
| Hospital Charge Code |
1740343
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Networks By Design Commercial |
$12.97
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$10.22
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$15.97
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]
|
Facility
OP
|
$19.96
|
|
|
Service Code
|
NDC 0065-0359-02
|
| Hospital Charge Code |
1740343
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.89
|
| Rate for Payer: BCBS Transplant Transplant |
$11.98
|
| Rate for Payer: Blue Shield of California Commercial |
$14.71
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$12.77
|
| Rate for Payer: Cigna of CA PPO |
$14.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.97
|
| Rate for Payer: Dignity Health Media |
$16.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$15.97
|
| Rate for Payer: Networks By Design Commercial |
$12.97
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Other HMO |
$9.98
|
| Rate for Payer: United Healthcare HMO Rider |
$9.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.97
|
|
|
CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
OP
|
$879.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$747.15 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$403.46
|
| Rate for Payer: BCBS Transplant Transplant |
$527.40
|
| Rate for Payer: BCBS Transplant Transplant |
$474.66
|
| Rate for Payer: Blue Shield of California Commercial |
$647.82
|
| Rate for Payer: Blue Shield of California Commercial |
$583.04
|
| Rate for Payer: Blue Shield of California Commercial |
$495.58
|
| 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 |
$395.55
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cigna of CA HMO |
$615.30
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA HMO |
$553.77
|
| Rate for Payer: Cigna of CA PPO |
$615.30
|
| Rate for Payer: Cigna of CA PPO |
$553.77
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| 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 |
$747.15
|
| Rate for Payer: Galaxy Health WC |
$672.44
|
| Rate for Payer: Galaxy Health WC |
$571.57
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Global Benefits Group Commercial |
$474.66
|
| Rate for Payer: Global Benefits Group Commercial |
$403.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$659.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$504.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$593.32
|
| 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: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.41
|
| 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 |
$189.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.38
|
| 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 |
$632.88
|
| Rate for Payer: Multiplan Commercial |
$537.94
|
| Rate for Payer: Multiplan Commercial |
$703.20
|
| Rate for Payer: Networks By Design Commercial |
$336.22
|
| Rate for Payer: Networks By Design Commercial |
$395.55
|
| Rate for Payer: Networks By Design Commercial |
$439.50
|
| Rate for Payer: Prime Health Services Commercial |
$747.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$527.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$527.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$439.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.22
|
| Rate for Payer: United Healthcare All Other HMO |
$395.55
|
| Rate for Payer: United Healthcare All Other HMO |
$439.50
|
| Rate for Payer: United Healthcare All Other HMO |
$336.22
|
| Rate for Payer: United Healthcare HMO Rider |
$439.50
|
| Rate for Payer: United Healthcare HMO Rider |
$395.55
|
| Rate for Payer: United Healthcare HMO Rider |
$336.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$439.50
|
| 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 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
IP
|
$879.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.96 |
| Max. Negotiated Rate |
$747.15 |
| Rate for Payer: Blue Shield of California Commercial |
$625.85
|
| Rate for Payer: Blue Shield of California Commercial |
$478.77
|
| Rate for Payer: Blue Shield of California Commercial |
$563.26
|
| Rate for Payer: Blue Shield of California EPN |
$450.05
|
| Rate for Payer: Blue Shield of California EPN |
$405.04
|
| Rate for Payer: Blue Shield of California EPN |
$344.28
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA HMO |
$615.30
|
| Rate for Payer: Cigna of CA HMO |
$553.77
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| Rate for Payer: Cigna of CA PPO |
$615.30
|
| Rate for Payer: Cigna of CA PPO |
$553.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$351.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$268.97
|
| Rate for Payer: Galaxy Health WC |
$571.57
|
| Rate for Payer: Galaxy Health WC |
$672.44
|
| Rate for Payer: Galaxy Health WC |
$747.15
|
| Rate for Payer: Global Benefits Group Commercial |
$474.66
|
| Rate for Payer: Global Benefits Group Commercial |
$403.46
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$334.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.38
|
| Rate for Payer: Multiplan Commercial |
$632.88
|
| Rate for Payer: Multiplan Commercial |
$703.20
|
| Rate for Payer: Multiplan Commercial |
$537.94
|
| Rate for Payer: Networks By Design Commercial |
$395.55
|
| Rate for Payer: Networks By Design Commercial |
$336.22
|
| Rate for Payer: Networks By Design Commercial |
$439.50
|
| Rate for Payer: Prime Health Services Commercial |
$672.44
|
| Rate for Payer: Prime Health Services Commercial |
$747.15
|
| Rate for Payer: Prime Health Services Commercial |
$571.57
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J8530
|
| Hospital Charge Code |
ERX206105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.45
|
| Rate for Payer: BCBS Transplant Transplant |
$2.42
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$2.83
|
| Rate for Payer: Cigna of CA PPO |
$2.83
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.43
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
IP
|
$4.04
|
|
|
Service Code
|
CPT J8530
|
| Hospital Charge Code |
ERX206105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$2.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$2.83
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.83
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.74
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: 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
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
IP
|
$336.23
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
ERX38271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$285.80 |
| 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 Commercial |
$158.06
|
| Rate for Payer: Blue Shield of California EPN |
$225.02
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Blue Shield of California EPN |
$172.15
|
| 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 |
$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 |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$373.58
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Global Benefits Group Commercial |
$263.70
|
| 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 |
$293.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.45
|
| 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: LLUH Dept of Risk Management WC |
$80.70
|
| 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 |
$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 |
$373.58
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$201.74
|
| Rate for Payer: BCBS Transplant Transplant |
$133.20
|
| Rate for Payer: BCBS Transplant Transplant |
$263.70
|
| 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 Commercial |
$163.61
|
| 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 |
$99.90
|
| Rate for Payer: Cash Price |
$197.78
|
| 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 |
$155.40
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| 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 |
$188.70
|
| Rate for Payer: Galaxy Health WC |
$373.58
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Global Benefits Group Commercial |
$263.70
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$166.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$329.62
|
| 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: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.65
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| 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: 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 |
$105.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.70
|
| 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 |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$268.98
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Networks By Design Commercial |
$219.75
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: Prime Health Services Commercial |
$373.58
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| 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 |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.12
|
| Rate for Payer: United Healthcare All Other HMO |
$219.75
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.12
|
| Rate for Payer: United Healthcare HMO Rider |
$219.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.12
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.65
|
| Rate for Payer: United Healthcare All Other HMO |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.50
|
|
|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
IP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$119.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.93
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$84.52
|
| 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 [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: Multiplan Commercial |
$112.70
|
| 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: Networks By Design Commercial |
$91.57
|
| Rate for Payer: Prime Health Services Commercial |
$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: Multiplan Commercial |
$4.48
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.36
|
| 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
IP
|
$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: Blue Shield of California Commercial |
$14.41
|
| Rate for Payer: Blue Shield of California Commercial |
$10.49
|
| Rate for Payer: Blue Shield of California Commercial |
$14.43
|
| Rate for Payer: Blue Shield of California EPN |
$7.55
|
| Rate for Payer: Blue Shield of California EPN |
$10.36
|
| Rate for Payer: Blue Shield of California EPN |
$10.38
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$10.32
|
| Rate for Payer: Cigna of CA HMO |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Cigna of CA PPO |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$17.23
|
| Rate for Payer: Galaxy Health WC |
$12.53
|
| Rate for Payer: Global Benefits Group Commercial |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.52
|
| 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 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 |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$16.19
|
| Rate for Payer: Multiplan Commercial |
$11.79
|
| Rate for Payer: Networks By Design Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.20
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
OP
|
$20.27
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1711475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$17.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.15
|
| 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: BCBS Transplant Transplant |
$12.14
|
| Rate for Payer: BCBS Transplant Transplant |
$12.16
|
| Rate for Payer: BCBS Transplant Transplant |
$8.84
|
| 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 |
$6.63
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$14.19
|
| 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: Dignity Health Commercial/Exchange |
$12.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Media |
$17.23
|
| Rate for Payer: Dignity Health Media |
$12.53
|
| Rate for Payer: Dignity Health Media |
$17.20
|
| 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 |
$8.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| 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 |
$12.53
|
| Rate for Payer: Galaxy Health WC |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$17.23
|
| Rate for Payer: Global Benefits Group Commercial |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.18
|
| 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 Commercial/Self Funded |
$9.83
|
| 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: 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 |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$16.19
|
| Rate for Payer: Multiplan Commercial |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$11.79
|
| Rate for Payer: Networks By Design Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.53
|
| 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 |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| 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 |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.53
|
| 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 |
$12.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.23
|
| Rate for Payer: Vantage Medical Group Senior |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$17.20
|
| Rate for Payer: Vantage Medical Group Senior |
$17.23
|
|
