|
CYCLOSPORINE 100 MG/ML ORAL SOLUTION [9708]
|
Facility
OP
|
$19.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1719136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cigna of CA HMO |
$13.76
|
| Rate for Payer: Cigna of CA PPO |
$13.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: BCBS Transplant Transplant |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.49
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.71
|
| Rate for Payer: Dignity Health Media |
$16.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$16.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$15.73
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Other HMO |
$9.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.71
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
CYCLOSPORINE 100 MG/ML ORAL SOLUTION [9708]
|
Facility
IP
|
$19.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1719136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Blue Shield of California Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California EPN |
$10.07
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cigna of CA HMO |
$13.76
|
| Rate for Payer: Cigna of CA PPO |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$16.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$15.73
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.71
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
OP
|
$15.78
|
|
|
Service Code
|
CPT J7516
|
| Hospital Charge Code |
NDG9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.61
|
| Rate for Payer: BCBS Transplant Transplant |
$9.47
|
| Rate for Payer: BCBS Transplant Transplant |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California EPN |
$46.93
|
| Rate for Payer: Blue Shield of California EPN |
$46.93
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Media |
$13.41
|
| Rate for Payer: Dignity Health Media |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$13.41
|
| Rate for Payer: Galaxy Health WC |
$7.98
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Commercial |
$7.98
|
| Rate for Payer: Prime Health Services Commercial |
$13.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.98
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
IP
|
$15.78
|
|
|
Service Code
|
CPT J7516
|
| Hospital Charge Code |
NDG9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$13.41 |
| Rate for Payer: Blue Shield of California Commercial |
$11.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.31
|
| Rate for Payer: Galaxy Health WC |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$13.41
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Multiplan Commercial |
$12.62
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Networks By Design Commercial |
$4.70
|
| Rate for Payer: Prime Health Services Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.98
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
OP
|
$5.07
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1711480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$2.21
|
| Rate for Payer: BCBS Transplant Transplant |
$3.04
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.31
|
| Rate for Payer: Dignity Health Media |
$4.35
|
| Rate for Payer: Dignity Health Media |
$3.14
|
| Rate for Payer: Dignity Health Media |
$4.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$4.31
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
IP
|
$5.12
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1711480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.55
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$2.95
|
| Rate for Payer: Prime Health Services Commercial |
$4.31
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
IP
|
$8.40
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1712179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
OP
|
$5.28
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1712179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: 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 |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: BCBS Transplant Transplant |
$3.17
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| 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 |
$3.78
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.49
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
OP
|
$13.59
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
NDG28844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: BCBS Transplant Transplant |
$5.69
|
| Rate for Payer: BCBS Transplant Transplant |
$3.40
|
| Rate for Payer: BCBS Transplant Transplant |
$8.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California Commercial |
$10.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6.99
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$9.51
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: Cigna of CA PPO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Media |
$8.07
|
| Rate for Payer: Dignity Health Media |
$11.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$10.87
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$11.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
IP
|
$9.49
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
NDG28844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$8.07 |
| Rate for Payer: Blue Shield of California Commercial |
$6.76
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$9.51
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: Cigna of CA PPO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$10.87
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
IP
|
$1.32
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1712180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
OP
|
$1.32
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1712180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Media |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-11
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Media |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-15
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Media |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
IP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-11
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
IP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-15
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
IP
|
$11.36
|
|
|
Service Code
|
NDC 51754-1007-1
|
| Hospital Charge Code |
NDG4294B
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Blue Shield of California Commercial |
$8.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.09
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
IP
|
$11.36
|
|
|
Service Code
|
NDC 51754-1007-3
|
| Hospital Charge Code |
NDG4294B
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Blue Shield of California Commercial |
$8.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.09
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
OP
|
$11.36
|
|
|
Service Code
|
NDC 51754-1007-1
|
| Hospital Charge Code |
NDG4294B
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.77
|
| Rate for Payer: BCBS Transplant Transplant |
$6.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.27
|
| Rate for Payer: Cigna of CA PPO |
$8.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: Dignity Health Media |
$9.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.09
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
OP
|
$11.36
|
|
|
Service Code
|
NDC 51754-1007-3
|
| Hospital Charge Code |
NDG4294B
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.77
|
| Rate for Payer: BCBS Transplant Transplant |
$6.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Cigna of CA HMO |
$7.27
|
| Rate for Payer: Cigna of CA PPO |
$8.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: Dignity Health Media |
$9.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$9.09
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
IP
|
$23,503.66
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$18,029.79 |
| Max. Negotiated Rate |
$23,503.66 |
| Rate for Payer: IEHP Medi-Cal |
$18,029.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,503.66
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
IP
|
$16,704.21
|
|
|
Service Code
|
APR-DRG 1311
|
| Min. Negotiated Rate |
$12,813.89 |
| Max. Negotiated Rate |
$16,704.21 |
| Rate for Payer: IEHP Medi-Cal |
$12,813.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,704.21
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
IP
|
$31,306.89
|
|
|
Service Code
|
APR-DRG 1313
|
| Min. Negotiated Rate |
$24,015.68 |
| Max. Negotiated Rate |
$31,306.89 |
| Rate for Payer: IEHP Medi-Cal |
$24,015.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,306.89
|
|
