|
GELATIN ABSORBABLE MUCOSAL POWDER [28017]
|
Facility
|
IP
|
$100.68
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Adventist Health Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$51.04
|
| Rate for Payer: Blue Shield of California Commercial |
$77.42
|
| Rate for Payer: Cash Price |
$45.31
|
| Rate for Payer: Cigna of CA HMO |
$70.48
|
| Rate for Payer: Cigna of CA PPO |
$70.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.27
|
| Rate for Payer: EPIC Health Plan Senior |
$40.27
|
| Rate for Payer: Galaxy Health WC |
$85.58
|
| Rate for Payer: Global Benefits Group Commercial |
$60.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.16
|
| Rate for Payer: Multiplan Commercial |
$80.54
|
| Rate for Payer: Networks By Design Commercial |
$50.34
|
| Rate for Payer: Prime Health Services Commercial |
$85.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.79
|
| Rate for Payer: United Healthcare All Other HMO |
$36.78
|
| Rate for Payer: United Healthcare HMO Rider |
$35.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.97
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER [28017]
|
Facility
|
OP
|
$100.68
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Adventist Health Commercial |
$20.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.51
|
| Rate for Payer: Cash Price |
$45.31
|
| Rate for Payer: Cigna of CA HMO |
$70.48
|
| Rate for Payer: Cigna of CA PPO |
$70.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.27
|
| Rate for Payer: EPIC Health Plan Senior |
$40.27
|
| Rate for Payer: Galaxy Health WC |
$85.58
|
| Rate for Payer: Global Benefits Group Commercial |
$60.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.48
|
| Rate for Payer: Multiplan Commercial |
$80.54
|
| Rate for Payer: Networks By Design Commercial |
$50.34
|
| Rate for Payer: Prime Health Services Commercial |
$85.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.79
|
| Rate for Payer: United Healthcare All Other HMO |
$36.78
|
| Rate for Payer: United Healthcare HMO Rider |
$35.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.58
|
| Rate for Payer: Vantage Medical Group Senior |
$85.58
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.68
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cigna of CA HMO |
$23.03
|
| Rate for Payer: Cigna of CA PPO |
$23.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.16
|
| Rate for Payer: EPIC Health Plan Senior |
$13.16
|
| Rate for Payer: Galaxy Health WC |
$27.96
|
| Rate for Payer: Global Benefits Group Commercial |
$19.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.03
|
| Rate for Payer: Multiplan Commercial |
$26.32
|
| Rate for Payer: Networks By Design Commercial |
$16.45
|
| Rate for Payer: Prime Health Services Commercial |
$27.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.35
|
| Rate for Payer: United Healthcare All Other HMO |
$12.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.96
|
| Rate for Payer: Vantage Medical Group Senior |
$27.96
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California Commercial |
$16.68
|
| Rate for Payer: Blue Shield of California Commercial |
$25.30
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cigna of CA HMO |
$23.03
|
| Rate for Payer: Cigna of CA PPO |
$23.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.16
|
| Rate for Payer: EPIC Health Plan Senior |
$13.16
|
| Rate for Payer: Galaxy Health WC |
$27.96
|
| Rate for Payer: Global Benefits Group Commercial |
$19.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$26.32
|
| Rate for Payer: Networks By Design Commercial |
$16.45
|
| Rate for Payer: Prime Health Services Commercial |
$27.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.35
|
| Rate for Payer: United Healthcare All Other HMO |
$12.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.77
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 200 TOPICAL SPONGE [28026]
|
Facility
|
IP
|
$106.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Adventist Health Commercial |
$21.24
|
| Rate for Payer: Blue Shield of California Commercial |
$53.84
|
| Rate for Payer: Blue Shield of California Commercial |
$81.67
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Cigna of CA HMO |
$74.34
|
| Rate for Payer: Cigna of CA PPO |
$74.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Senior |
$42.48
|
| Rate for Payer: Galaxy Health WC |
$90.27
|
| Rate for Payer: Global Benefits Group Commercial |
$63.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$84.96
|
| Rate for Payer: Networks By Design Commercial |
$53.10
|
| Rate for Payer: Prime Health Services Commercial |
$90.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.86
|
| Rate for Payer: United Healthcare All Other HMO |
$38.79
|
| Rate for Payer: United Healthcare HMO Rider |
$37.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.78
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 200 TOPICAL SPONGE [28026]
|
Facility
|
OP
|
$106.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Adventist Health Commercial |
$21.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.65
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Cigna of CA HMO |
$74.34
|
| Rate for Payer: Cigna of CA PPO |
$74.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Senior |
$42.48
|
| Rate for Payer: Galaxy Health WC |
$90.27
|
| Rate for Payer: Global Benefits Group Commercial |
$63.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$84.96
|
| Rate for Payer: Networks By Design Commercial |
$53.10
|
| Rate for Payer: Prime Health Services Commercial |
$90.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.86
|
| Rate for Payer: United Healthcare All Other HMO |
$38.79
|
| Rate for Payer: United Healthcare HMO Rider |
$37.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.27
|
| Rate for Payer: Vantage Medical Group Senior |
$90.27
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]
|
Facility
|
OP
|
$37.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.79
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cigna of CA HMO |
$25.93
|
| Rate for Payer: Cigna of CA PPO |
$25.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Senior |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$31.49
|
| Rate for Payer: Global Benefits Group Commercial |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$29.64
|
| Rate for Payer: Networks By Design Commercial |
$18.52
|
| Rate for Payer: Prime Health Services Commercial |
$31.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.90
|
| Rate for Payer: United Healthcare All Other HMO |
$13.53
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.49
|
| Rate for Payer: Vantage Medical Group Senior |
$31.49
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]
|
Facility
|
IP
|
$37.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Galaxy Health WC |
$31.49
|
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.78
|
| Rate for Payer: Blue Shield of California Commercial |
$28.49
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cigna of CA HMO |
$25.93
|
| Rate for Payer: Cigna of CA PPO |
$25.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Senior |
$14.82
|
| Rate for Payer: Global Benefits Group Commercial |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$29.64
|
| Rate for Payer: Networks By Design Commercial |
$18.52
|
| Rate for Payer: Prime Health Services Commercial |
$31.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.90
|
| Rate for Payer: United Healthcare All Other HMO |
$13.53
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.13
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
HCPCS J9196
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$12.18
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cigna of CA HMO |
$11.09
|
| Rate for Payer: Cigna of CA PPO |
$11.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Senior |
$6.34
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$12.67
|
| Rate for Payer: Networks By Design Commercial |
$7.92
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.94
|
| Rate for Payer: United Healthcare All Other HMO |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.19
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
HCPCS J9196
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$54.43 |
| Rate for Payer: Dignity Health Medi-Cal |
$13.46
|
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.32
|
| Rate for Payer: Blue Shield of California Commercial |
$13.31
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cigna of CA HMO |
$11.09
|
| Rate for Payer: Cigna of CA PPO |
$11.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Senior |
$6.34
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$12.67
|
| Rate for Payer: Networks By Design Commercial |
$7.92
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.94
|
| Rate for Payer: United Healthcare All Other HMO |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [191075]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.45
|
| Rate for Payer: Cigna of CA PPO |
$1.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: EPIC Health Plan Senior |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$1.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1.76
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [191075]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.45
|
| Rate for Payer: Cigna of CA PPO |
$1.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: EPIC Health Plan Senior |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$1.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]
|
Facility
|
OP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$38.58
|
| Rate for Payer: Cigna of CA PPO |
$38.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$46.85
|
| Rate for Payer: Global Benefits Group Commercial |
$33.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.58
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Networks By Design Commercial |
$27.56
|
| Rate for Payer: Prime Health Services Commercial |
$46.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.69
|
| Rate for Payer: United Healthcare All Other HMO |
$20.14
|
| Rate for Payer: United Healthcare HMO Rider |
$19.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.85
|
| Rate for Payer: Vantage Medical Group Senior |
$46.85
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$27.95
|
| Rate for Payer: Blue Shield of California Commercial |
$42.39
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$38.58
|
| Rate for Payer: Cigna of CA PPO |
$38.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$46.85
|
| Rate for Payer: Global Benefits Group Commercial |
$33.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Networks By Design Commercial |
$27.56
|
| Rate for Payer: Prime Health Services Commercial |
$46.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.69
|
| Rate for Payer: United Healthcare All Other HMO |
$20.14
|
| Rate for Payer: United Healthcare HMO Rider |
$19.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.05
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [400398]
|
Facility
|
OP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$38.58
|
| Rate for Payer: Cigna of CA PPO |
$38.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$46.85
|
| Rate for Payer: Global Benefits Group Commercial |
$33.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.58
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Networks By Design Commercial |
$27.56
|
| Rate for Payer: Prime Health Services Commercial |
$46.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.69
|
| Rate for Payer: United Healthcare All Other HMO |
$20.14
|
| Rate for Payer: United Healthcare HMO Rider |
$19.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.85
|
| Rate for Payer: Vantage Medical Group Senior |
$46.85
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [400398]
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$27.95
|
| Rate for Payer: Blue Shield of California Commercial |
$42.39
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$38.58
|
| Rate for Payer: Cigna of CA PPO |
$38.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$46.85
|
| Rate for Payer: Global Benefits Group Commercial |
$33.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Networks By Design Commercial |
$27.56
|
| Rate for Payer: Prime Health Services Commercial |
$46.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.69
|
| Rate for Payer: United Healthcare All Other HMO |
$20.14
|
| Rate for Payer: United Healthcare HMO Rider |
$19.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.05
|
|
|
GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION [191077]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.41
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
|
|
GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION [191077]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA HMO |
$0.80
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$0.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.50
|
|
|
GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]
|
Facility
|
IP
|
$14.46
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Multiplan Commercial |
$10.67
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$6.67
|
| Rate for Payer: Networks By Design Commercial |
$7.23
|
| Rate for Payer: Networks By Design Commercial |
$5.51
|
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.76
|
| Rate for Payer: Blue Shield of California Commercial |
$10.26
|
| Rate for Payer: Blue Shield of California Commercial |
$8.48
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5.59
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna of CA HMO |
$10.12
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$7.72
|
| Rate for Payer: Cigna of CA HMO |
$9.34
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$7.72
|
| Rate for Payer: Cigna of CA PPO |
$9.34
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.41
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.34
|
| Rate for Payer: Galaxy Health WC |
$11.34
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.17
|
| Rate for Payer: United Healthcare HMO Rider |
$4.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.61
|
|
|
GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]
|
Facility
|
OP
|
$11.03
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Cigna of CA PPO |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$10.67
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Networks By Design Commercial |
$5.51
|
| Rate for Payer: Networks By Design Commercial |
$7.23
|
| Rate for Payer: Networks By Design Commercial |
$6.67
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna of CA HMO |
$10.12
|
| Rate for Payer: Cigna of CA HMO |
$9.34
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA HMO |
$7.72
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.12
|
| Rate for Payer: Cigna of CA PPO |
$7.72
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.41
|
| Rate for Payer: EPIC Health Plan Senior |
$5.34
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$11.34
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Prime Health Services Commercial |
$11.34
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$5.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$4.77
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.38
|
| Rate for Payer: Vantage Medical Group Senior |
$11.34
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: EPIC Health Plan Senior |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Galaxy Health WC |
$1.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.45
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: EPIC Health Plan Senior |
$0.83
|
| Rate for Payer: EPIC Health Plan Senior |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$1.41
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1.76
|
|
|
GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]
|
Facility
|
OP
|
$140.94
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Adventist Health Commercial |
$28.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Cigna of CA HMO |
$98.66
|
| Rate for Payer: Cigna of CA PPO |
$98.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.38
|
| Rate for Payer: EPIC Health Plan Senior |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$119.80
|
| Rate for Payer: Global Benefits Group Commercial |
$84.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.66
|
| Rate for Payer: Multiplan Commercial |
$112.75
|
| Rate for Payer: Networks By Design Commercial |
$70.47
|
| Rate for Payer: Prime Health Services Commercial |
$119.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.89
|
| Rate for Payer: United Healthcare All Other HMO |
$51.49
|
| Rate for Payer: United Healthcare HMO Rider |
$50.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.80
|
| Rate for Payer: Vantage Medical Group Senior |
$119.80
|
|
|
GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]
|
Facility
|
IP
|
$140.94
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$119.80 |
| Rate for Payer: Adventist Health Commercial |
$28.19
|
| Rate for Payer: Blue Shield of California Commercial |
$108.38
|
| Rate for Payer: Blue Shield of California Commercial |
$71.46
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Cigna of CA HMO |
$98.66
|
| Rate for Payer: Cigna of CA PPO |
$98.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.38
|
| Rate for Payer: EPIC Health Plan Senior |
$56.38
|
| Rate for Payer: Galaxy Health WC |
$119.80
|
| Rate for Payer: Global Benefits Group Commercial |
$84.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.83
|
| Rate for Payer: Multiplan Commercial |
$112.75
|
| Rate for Payer: Networks By Design Commercial |
$70.47
|
| Rate for Payer: Prime Health Services Commercial |
$119.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.89
|
| Rate for Payer: United Healthcare All Other HMO |
$51.49
|
| Rate for Payer: United Healthcare HMO Rider |
$50.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.16
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 6586262460
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
