|
GELATIN ABSORBABLE EYE FILM [28028]
|
Facility
|
OP
|
$268.54
|
|
|
Service Code
|
NDC 0009-0297-01
|
| Hospital Charge Code |
ERX28028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$228.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$176.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$228.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.00
|
| Rate for Payer: Blue Distinction Transplant |
$161.12
|
| Rate for Payer: Blue Shield of California Commercial |
$197.91
|
| Rate for Payer: Blue Shield of California EPN |
$156.83
|
| Rate for Payer: Cash Price |
$120.84
|
| Rate for Payer: Cigna of CA HMO |
$171.87
|
| Rate for Payer: Cigna of CA PPO |
$198.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$228.26
|
| Rate for Payer: Dignity Health Media |
$228.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.42
|
| Rate for Payer: Galaxy Health WC |
$228.26
|
| Rate for Payer: Global Benefits Group Commercial |
$161.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$201.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.45
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Networks By Design Commercial |
$174.55
|
| Rate for Payer: Prime Health Services Commercial |
$228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.27
|
| Rate for Payer: United Healthcare All Other HMO |
$134.27
|
| Rate for Payer: United Healthcare HMO Rider |
$134.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$228.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$228.26
|
|
|
GELATIN ABSORBABLE EYE FILM [28028]
|
Facility
|
IP
|
$268.54
|
|
|
Service Code
|
NDC 0009-0297-01
|
| Hospital Charge Code |
ERX28028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$228.26 |
| Rate for Payer: Blue Shield of California Commercial |
$191.20
|
| Rate for Payer: Blue Shield of California EPN |
$137.49
|
| Rate for Payer: Cash Price |
$120.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.42
|
| Rate for Payer: Galaxy Health WC |
$228.26
|
| Rate for Payer: Global Benefits Group Commercial |
$161.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.45
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Networks By Design Commercial |
$174.55
|
| Rate for Payer: Prime Health Services Commercial |
$228.26
|
|
|
GELATIN ABSORBABLE IMPLANT FILM [111340]
|
Facility
|
IP
|
$2,441.98
|
|
|
Service Code
|
NDC 0009-0283-01
|
| Hospital Charge Code |
1780004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$2,075.68 |
| Rate for Payer: Blue Shield of California Commercial |
$1,738.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,250.29
|
| Rate for Payer: Cash Price |
$1,098.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.79
|
| Rate for Payer: Galaxy Health WC |
$2,075.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,628.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.08
|
| Rate for Payer: Multiplan Commercial |
$1,953.58
|
| Rate for Payer: Networks By Design Commercial |
$1,587.29
|
| Rate for Payer: Prime Health Services Commercial |
$2,075.68
|
|
|
GELATIN ABSORBABLE IMPLANT FILM [111340]
|
Facility
|
OP
|
$2,441.98
|
|
|
Service Code
|
NDC 0009-0283-01
|
| Hospital Charge Code |
1780004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$2,075.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,601.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,075.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,343.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,343.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,454.93
|
| Rate for Payer: Blue Distinction Transplant |
$1,465.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,799.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,426.12
|
| Rate for Payer: Cash Price |
$1,098.89
|
| Rate for Payer: Cigna of CA HMO |
$1,562.87
|
| Rate for Payer: Cigna of CA PPO |
$1,807.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,075.68
|
| Rate for Payer: Dignity Health Media |
$2,075.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,075.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$976.79
|
| Rate for Payer: Galaxy Health WC |
$2,075.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,831.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,628.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.08
|
| Rate for Payer: Multiplan Commercial |
$1,953.58
|
| Rate for Payer: Networks By Design Commercial |
$1,587.29
|
| Rate for Payer: Prime Health Services Commercial |
$2,075.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,465.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,465.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,220.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,220.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,220.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,220.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,075.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,075.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,075.68
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER [28017]
|
Facility
|
OP
|
$91.32
|
|
|
Service Code
|
NDC 0009-0433-04
|
| Hospital Charge Code |
1743583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$77.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.41
|
| Rate for Payer: Blue Distinction Transplant |
$54.79
|
| Rate for Payer: Blue Shield of California Commercial |
$67.30
|
| Rate for Payer: Blue Shield of California EPN |
$53.33
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: Cigna of CA HMO |
$58.44
|
| Rate for Payer: Cigna of CA PPO |
$67.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.62
|
| Rate for Payer: Dignity Health Media |
$77.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.53
|
| Rate for Payer: Galaxy Health WC |
$77.62
|
| Rate for Payer: Global Benefits Group Commercial |
$54.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$68.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$73.06
|
| Rate for Payer: Networks By Design Commercial |
$59.36
|
| Rate for Payer: Prime Health Services Commercial |
$77.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.66
|
| Rate for Payer: United Healthcare All Other HMO |
$45.66
|
| Rate for Payer: United Healthcare HMO Rider |
$45.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.62
|
| Rate for Payer: Vantage Medical Group Senior |
$77.62
|
|
|
GELATIN ABSORBABLE MUCOSAL POWDER [28017]
|
Facility
|
IP
|
$91.32
|
|
|
Service Code
|
NDC 0009-0433-04
|
| Hospital Charge Code |
1743583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$77.62 |
| Rate for Payer: Blue Shield of California Commercial |
$65.02
|
| Rate for Payer: Blue Shield of California EPN |
$46.76
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.53
|
| Rate for Payer: Galaxy Health WC |
$77.62
|
| Rate for Payer: Global Benefits Group Commercial |
$54.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$73.06
|
| Rate for Payer: Networks By Design Commercial |
$59.36
|
| Rate for Payer: Prime Health Services Commercial |
$77.62
|
|
|
GELATIN GELFOAM PLUS WITH THROMBIN 2500 UNITS KIT [4080737]
|
Facility
|
IP
|
$212.50
|
|
|
Service Code
|
NDC 85412-863-04
|
| Hospital Charge Code |
1796131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Blue Shield of California Commercial |
$151.30
|
| Rate for Payer: Blue Shield of California EPN |
$108.80
|
| Rate for Payer: Cash Price |
$95.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.00
|
| Rate for Payer: Galaxy Health WC |
$180.62
|
| Rate for Payer: Global Benefits Group Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$170.00
|
| Rate for Payer: Networks By Design Commercial |
$138.12
|
| Rate for Payer: Prime Health Services Commercial |
$180.62
|
|
|
GELATIN GELFOAM PLUS WITH THROMBIN 2500 UNITS KIT [4080737]
|
Facility
|
OP
|
$212.32
|
|
|
Service Code
|
NDC 85412-863-09
|
| Hospital Charge Code |
1796131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$180.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.50
|
| Rate for Payer: Blue Distinction Transplant |
$127.39
|
| Rate for Payer: Blue Shield of California Commercial |
$156.48
|
| Rate for Payer: Blue Shield of California EPN |
$123.99
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: Cigna of CA HMO |
$135.88
|
| Rate for Payer: Cigna of CA PPO |
$157.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.47
|
| Rate for Payer: Dignity Health Media |
$180.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.93
|
| Rate for Payer: Galaxy Health WC |
$180.47
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.96
|
| Rate for Payer: Multiplan Commercial |
$169.86
|
| Rate for Payer: Networks By Design Commercial |
$138.01
|
| Rate for Payer: Prime Health Services Commercial |
$180.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.16
|
| Rate for Payer: United Healthcare All Other HMO |
$106.16
|
| Rate for Payer: United Healthcare HMO Rider |
$106.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.47
|
| Rate for Payer: Vantage Medical Group Senior |
$180.47
|
|
|
GELATIN GELFOAM PLUS WITH THROMBIN 2500 UNITS KIT [4080737]
|
Facility
|
OP
|
$212.50
|
|
|
Service Code
|
NDC 85412-863-04
|
| Hospital Charge Code |
1796131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.61
|
| Rate for Payer: Blue Distinction Transplant |
$127.50
|
| Rate for Payer: Blue Shield of California Commercial |
$156.61
|
| Rate for Payer: Blue Shield of California EPN |
$124.10
|
| Rate for Payer: Cash Price |
$95.63
|
| Rate for Payer: Cigna of CA HMO |
$136.00
|
| Rate for Payer: Cigna of CA PPO |
$157.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.62
|
| Rate for Payer: Dignity Health Media |
$180.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.00
|
| Rate for Payer: Galaxy Health WC |
$180.62
|
| Rate for Payer: Global Benefits Group Commercial |
$127.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$170.00
|
| Rate for Payer: Networks By Design Commercial |
$138.12
|
| Rate for Payer: Prime Health Services Commercial |
$180.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.25
|
| Rate for Payer: United Healthcare All Other HMO |
$106.25
|
| Rate for Payer: United Healthcare HMO Rider |
$106.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.62
|
| Rate for Payer: Vantage Medical Group Senior |
$180.62
|
|
|
GELATIN GELFOAM PLUS WITH THROMBIN 2500 UNITS KIT [4080737]
|
Facility
|
IP
|
$212.32
|
|
|
Service Code
|
NDC 85412-863-09
|
| Hospital Charge Code |
1796131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$180.47 |
| Rate for Payer: Blue Shield of California Commercial |
$151.17
|
| Rate for Payer: Blue Shield of California EPN |
$108.71
|
| Rate for Payer: Cash Price |
$95.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.93
|
| Rate for Payer: Galaxy Health WC |
$180.47
|
| Rate for Payer: Global Benefits Group Commercial |
$127.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.96
|
| Rate for Payer: Multiplan Commercial |
$169.86
|
| Rate for Payer: Networks By Design Commercial |
$138.01
|
| Rate for Payer: Prime Health Services Commercial |
$180.47
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]
|
Facility
|
IP
|
$50.24
|
|
|
Service Code
|
NDC 0009-0342-01
|
| Hospital Charge Code |
1743565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$42.70 |
| Rate for Payer: Blue Shield of California Commercial |
$35.77
|
| Rate for Payer: Blue Shield of California EPN |
$25.72
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.10
|
| Rate for Payer: Galaxy Health WC |
$42.70
|
| Rate for Payer: Global Benefits Group Commercial |
$30.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: Networks By Design Commercial |
$32.66
|
| Rate for Payer: Prime Health Services Commercial |
$42.70
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]
|
Facility
|
OP
|
$50.24
|
|
|
Service Code
|
NDC 0009-0342-01
|
| Hospital Charge Code |
1743565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$42.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.93
|
| Rate for Payer: Blue Distinction Transplant |
$30.14
|
| Rate for Payer: Blue Shield of California Commercial |
$37.03
|
| Rate for Payer: Blue Shield of California EPN |
$29.34
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Cigna of CA HMO |
$32.15
|
| Rate for Payer: Cigna of CA PPO |
$37.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.70
|
| Rate for Payer: Dignity Health Media |
$42.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.10
|
| Rate for Payer: Galaxy Health WC |
$42.70
|
| Rate for Payer: Global Benefits Group Commercial |
$30.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: Networks By Design Commercial |
$32.66
|
| Rate for Payer: Prime Health Services Commercial |
$42.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.12
|
| Rate for Payer: United Healthcare All Other HMO |
$25.12
|
| Rate for Payer: United Healthcare HMO Rider |
$25.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.70
|
| Rate for Payer: Vantage Medical Group Senior |
$42.70
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 200 TOPICAL SPONGE [28026]
|
Facility
|
IP
|
$96.33
|
|
|
Service Code
|
NDC 0009-0349-03
|
| Hospital Charge Code |
ERX28026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Blue Shield of California Commercial |
$68.59
|
| Rate for Payer: Blue Shield of California EPN |
$49.32
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.53
|
| Rate for Payer: Galaxy Health WC |
$81.88
|
| Rate for Payer: Global Benefits Group Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$77.06
|
| Rate for Payer: Networks By Design Commercial |
$62.61
|
| Rate for Payer: Prime Health Services Commercial |
$81.88
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 200 TOPICAL SPONGE [28026]
|
Facility
|
OP
|
$96.33
|
|
|
Service Code
|
NDC 0009-0349-03
|
| Hospital Charge Code |
ERX28026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.39
|
| Rate for Payer: Blue Distinction Transplant |
$57.80
|
| Rate for Payer: Blue Shield of California Commercial |
$71.00
|
| Rate for Payer: Blue Shield of California EPN |
$56.26
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cigna of CA HMO |
$61.65
|
| Rate for Payer: Cigna of CA PPO |
$71.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.88
|
| Rate for Payer: Dignity Health Media |
$81.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.53
|
| Rate for Payer: Galaxy Health WC |
$81.88
|
| Rate for Payer: Global Benefits Group Commercial |
$57.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$77.06
|
| Rate for Payer: Networks By Design Commercial |
$62.61
|
| Rate for Payer: Prime Health Services Commercial |
$81.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.16
|
| Rate for Payer: United Healthcare All Other HMO |
$48.16
|
| Rate for Payer: United Healthcare HMO Rider |
$48.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.88
|
| Rate for Payer: Vantage Medical Group Senior |
$81.88
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 4 TOPICAL SPONGE [28023]
|
Facility
|
OP
|
$16.16
|
|
|
Service Code
|
NDC 0009-0396-05
|
| Hospital Charge Code |
ERX28023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$13.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.63
|
| Rate for Payer: Blue Distinction Transplant |
$9.70
|
| Rate for Payer: Blue Shield of California Commercial |
$11.91
|
| Rate for Payer: Blue Shield of California EPN |
$9.44
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: Cigna of CA HMO |
$10.34
|
| Rate for Payer: Cigna of CA PPO |
$11.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.74
|
| Rate for Payer: Dignity Health Media |
$13.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.46
|
| Rate for Payer: Galaxy Health WC |
$13.74
|
| Rate for Payer: Global Benefits Group Commercial |
$9.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$12.93
|
| Rate for Payer: Networks By Design Commercial |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$13.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.08
|
| Rate for Payer: United Healthcare HMO Rider |
$8.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 4 TOPICAL SPONGE [28023]
|
Facility
|
IP
|
$16.16
|
|
|
Service Code
|
NDC 0009-0396-05
|
| Hospital Charge Code |
ERX28023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$13.74 |
| Rate for Payer: Blue Shield of California Commercial |
$11.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.27
|
| Rate for Payer: Cash Price |
$7.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.46
|
| Rate for Payer: Galaxy Health WC |
$13.74
|
| Rate for Payer: Global Benefits Group Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$12.93
|
| Rate for Payer: Networks By Design Commercial |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$13.74
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]
|
Facility
|
IP
|
$33.61
|
|
|
Service Code
|
NDC 0009-0323-01
|
| Hospital Charge Code |
1743564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Blue Shield of California Commercial |
$23.93
|
| Rate for Payer: Blue Shield of California EPN |
$17.21
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.57
|
| Rate for Payer: Global Benefits Group Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
| Rate for Payer: Networks By Design Commercial |
$21.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.57
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]
|
Facility
|
OP
|
$33.61
|
|
|
Service Code
|
NDC 0009-0323-01
|
| Hospital Charge Code |
1743564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.02
|
| Rate for Payer: Blue Distinction Transplant |
$20.17
|
| Rate for Payer: Blue Shield of California Commercial |
$24.77
|
| Rate for Payer: Blue Shield of California EPN |
$19.63
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$21.51
|
| Rate for Payer: Cigna of CA PPO |
$24.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.57
|
| Rate for Payer: Dignity Health Media |
$28.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.57
|
| Rate for Payer: Global Benefits Group Commercial |
$20.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$26.89
|
| Rate for Payer: Networks By Design Commercial |
$21.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.57
|
| Rate for Payer: Vantage Medical Group Senior |
$28.57
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
CPT J9196
|
| Hospital Charge Code |
NDG220785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Blue Shield of California Commercial |
$11.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.11
|
| 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: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.34
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| 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 |
$5.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5.84
|
| Rate for Payer: United Healthcare HMO Rider |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.23
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
CPT J9196
|
| Hospital Charge Code |
NDG220785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$55.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.44
|
| Rate for Payer: Blue Distinction Transplant |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11.67
|
| Rate for Payer: Blue Shield of California EPN |
$9.25
|
| 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 |
$17.26
|
| Rate for Payer: Dignity Health Media |
$11.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.51
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.42
|
| 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 |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.51
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
IP
|
$6.65
|
|
|
Service Code
|
CPT J9196
|
| Hospital Charge Code |
NDG220785B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Blue Shield of California Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna of CA HMO |
$4.66
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.66
|
| Rate for Payer: Galaxy Health WC |
$5.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2.45
|
| Rate for Payer: United Healthcare HMO Rider |
$2.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
OP
|
$6.65
|
|
|
Service Code
|
CPT J9196
|
| Hospital Charge Code |
NDG220785B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$55.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.96
|
| Rate for Payer: Blue Distinction Transplant |
$3.99
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.88
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna of CA HMO |
$4.66
|
| Rate for Payer: Cigna of CA PPO |
$4.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.26
|
| Rate for Payer: Dignity Health Media |
$11.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.51
|
| Rate for Payer: Galaxy Health WC |
$5.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.42
|
| Rate for Payer: Multiplan Commercial |
$5.32
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.51
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [191075]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
NDG191075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$226.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| 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 |
$1.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: Blue Distinction Transplant |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| 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 Media |
$1.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$1.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| 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 |
$1.04
|
| 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 |
$1.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.04
|
| 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
|
CPT J9201
|
| Hospital Charge Code |
NDG191075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| 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: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$1.76
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.79
|
| 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 |
$1.04
|
| 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 |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
1755609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Blue Shield of California Commercial |
$39.25
|
| Rate for Payer: Blue Shield of California Commercial |
$40.16
|
| Rate for Payer: Blue Shield of California EPN |
$28.22
|
| Rate for Payer: Blue Shield of California EPN |
$28.88
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Cigna of CA HMO |
$38.58
|
| Rate for Payer: Cigna of CA HMO |
$39.48
|
| Rate for Payer: Cigna of CA PPO |
$39.48
|
| Rate for Payer: Cigna of CA PPO |
$38.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.56
|
| Rate for Payer: Galaxy Health WC |
$46.85
|
| Rate for Payer: Galaxy Health WC |
$47.94
|
| Rate for Payer: Global Benefits Group Commercial |
$33.84
|
| Rate for Payer: Global Benefits Group Commercial |
$33.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$45.12
|
| Rate for Payer: Networks By Design Commercial |
$27.56
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$46.85
|
| Rate for Payer: Prime Health Services Commercial |
$47.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.30
|
| Rate for Payer: United Healthcare All Other HMO |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$20.80
|
| Rate for Payer: United Healthcare HMO Rider |
$19.89
|
| Rate for Payer: United Healthcare HMO Rider |
$20.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.61
|
|
