|
GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]
|
Facility
IP
|
$12.19
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
1755759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: Blue Shield of California Commercial |
$8.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7.85
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$10.25
|
| Rate for Payer: Blue Shield of California Commercial |
$10.30
|
| Rate for Payer: Blue Shield of California EPN |
$5.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$7.40
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$8.10
|
| 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 |
$8.53
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$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 |
$8.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| 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 |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| 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: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Networks By Design Commercial |
$7.23
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$6.10
|
| Rate for Payer: Networks By Design Commercial |
$5.52
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.36
|
| 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 |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
1755759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$226.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: BCBS Transplant Transplant |
$8.68
|
| Rate for Payer: BCBS Transplant Transplant |
$6.62
|
| Rate for Payer: BCBS Transplant Transplant |
$8.64
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: BCBS Transplant Transplant |
$7.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$10.61
|
| Rate for Payer: Blue Shield of California Commercial |
$8.13
|
| Rate for Payer: Blue Shield of California Commercial |
$10.66
|
| Rate for Payer: Blue Shield of California Commercial |
$8.98
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$10.12
|
| Rate for Payer: Cigna of CA HMO |
$7.72
|
| Rate for Payer: Cigna of CA HMO |
$8.53
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$7.72
|
| Rate for Payer: Cigna of CA PPO |
$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 |
$8.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$9.38
|
| Rate for Payer: Dignity Health Media |
$10.36
|
| Rate for Payer: Dignity Health Media |
$12.24
|
| Rate for Payer: Dignity Health Media |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| 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 |
$4.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$12.29
|
| Rate for Payer: Galaxy Health WC |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.31
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$8.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| 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: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.52
|
| Rate for Payer: Networks By Design Commercial |
$6.10
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$7.23
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.29
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.52
|
| Rate for Payer: United Healthcare All Other HMO |
$7.23
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$6.10
|
| Rate for Payer: United Healthcare HMO Rider |
$6.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7.23
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$5.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.38
|
| 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 |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.36
|
| Rate for Payer: Vantage Medical Group Senior |
$9.38
|
| Rate for Payer: Vantage Medical Group Senior |
$10.36
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]
|
Facility
IP
|
$1.76
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
NDG191076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.41
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]
|
Facility
OP
|
$1.76
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
NDG191076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$226.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: BCBS Transplant Transplant |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.23
|
| Rate for Payer: Cigna of CA PPO |
$1.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: Dignity Health Media |
$1.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.41
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.88
|
| 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 Senior |
$1.50
|
|
|
GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]
|
Facility
IP
|
$136.18
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
ERX105417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$115.75 |
| Rate for Payer: Blue Shield of California Commercial |
$96.96
|
| Rate for Payer: Blue Shield of California EPN |
$69.72
|
| Rate for Payer: Cash Price |
$61.28
|
| Rate for Payer: Cigna of CA HMO |
$95.33
|
| Rate for Payer: Cigna of CA PPO |
$95.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.47
|
| Rate for Payer: Galaxy Health WC |
$115.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.68
|
| Rate for Payer: Multiplan Commercial |
$108.94
|
| Rate for Payer: Networks By Design Commercial |
$68.09
|
| Rate for Payer: Prime Health Services Commercial |
$115.75
|
|
|
GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]
|
Facility
OP
|
$136.18
|
|
|
Service Code
|
CPT J9201
|
| Hospital Charge Code |
ERX105417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$226.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$115.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$74.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.29
|
| Rate for Payer: BCBS Transplant Transplant |
$81.71
|
| Rate for Payer: Blue Shield of California Commercial |
$100.36
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Cash Price |
$61.28
|
| Rate for Payer: Cash Price |
$61.28
|
| Rate for Payer: Cigna of CA HMO |
$95.33
|
| Rate for Payer: Cigna of CA PPO |
$95.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.75
|
| Rate for Payer: Dignity Health Media |
$115.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.47
|
| Rate for Payer: Galaxy Health WC |
$115.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$102.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.68
|
| Rate for Payer: Multiplan Commercial |
$108.94
|
| Rate for Payer: Networks By Design Commercial |
$68.09
|
| Rate for Payer: Prime Health Services Commercial |
$115.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.09
|
| Rate for Payer: United Healthcare All Other HMO |
$68.09
|
| Rate for Payer: United Healthcare HMO Rider |
$68.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.75
|
| Rate for Payer: Vantage Medical Group Senior |
$115.75
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
OP
|
$0.21
|
|
|
Service Code
|
NDC 69097-821-03
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| 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 Media |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| 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
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
OP
|
$0.21
|
|
|
Service Code
|
NDC 65862-624-60
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: BCBS Transplant Transplant |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| 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 Media |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.13
|
| 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
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
NDC 60687-224-11
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
NDC 65862-624-60
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| 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: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
NDC 60687-224-01
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
NDC 69097-821-03
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| 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: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
IP
|
$0.31
|
|
|
Service Code
|
NDC 60687-224-01
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
OP
|
$0.31
|
|
|
Service Code
|
NDC 60687-224-11
|
| Hospital Charge Code |
1711318
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: BCBS Transplant Transplant |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN [219685]
|
Facility
OP
|
$11,527.46
|
|
|
Service Code
|
CPT J9203
|
| Hospital Charge Code |
1755680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.28 |
| Max. Negotiated Rate |
$9,798.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$445.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$282.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$248.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.35
|
| Rate for Payer: BCBS Transplant Transplant |
$6,916.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,495.74
|
| Rate for Payer: Blue Shield of California EPN |
$231.98
|
| Rate for Payer: Cash Price |
$5,187.36
|
| Rate for Payer: Cash Price |
$5,187.36
|
| Rate for Payer: Cigna of CA HMO |
$8,069.22
|
| Rate for Payer: Cigna of CA PPO |
$8,069.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.42
|
| Rate for Payer: Dignity Health Media |
$226.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$226.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.28
|
| Rate for Payer: Galaxy Health WC |
$9,798.34
|
| Rate for Payer: Global Benefits Group Commercial |
$6,916.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,645.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$371.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$371.10
|
| Rate for Payer: IEHP Medi-Cal |
$366.57
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$366.57
|
| Rate for Payer: IEHP Medicare Advantage |
$226.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,688.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,766.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.22
|
| Rate for Payer: Multiplan Commercial |
$9,221.97
|
| Rate for Payer: Networks By Design Commercial |
$5,763.73
|
| Rate for Payer: Prime Health Services Commercial |
$9,798.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,916.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,916.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,763.73
|
| Rate for Payer: United Healthcare All Other HMO |
$5,763.73
|
| Rate for Payer: United Healthcare HMO Rider |
$5,763.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,763.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.91
|
| Rate for Payer: Vantage Medical Group Senior |
$226.28
|
|
|
GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN [219685]
|
Facility
IP
|
$11,527.46
|
|
|
Service Code
|
CPT J9203
|
| Hospital Charge Code |
1755680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,766.59 |
| Max. Negotiated Rate |
$9,798.34 |
| Rate for Payer: Blue Shield of California Commercial |
$8,207.55
|
| Rate for Payer: Blue Shield of California EPN |
$5,902.06
|
| Rate for Payer: Cash Price |
$5,187.36
|
| Rate for Payer: Cigna of CA HMO |
$8,069.22
|
| Rate for Payer: Cigna of CA PPO |
$8,069.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,610.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,610.98
|
| Rate for Payer: Galaxy Health WC |
$9,798.34
|
| Rate for Payer: Global Benefits Group Commercial |
$6,916.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,688.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,391.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,766.59
|
| Rate for Payer: Multiplan Commercial |
$9,221.97
|
| Rate for Payer: Networks By Design Commercial |
$5,763.73
|
| Rate for Payer: Prime Health Services Commercial |
$9,798.34
|
|
|
Genioplasty; sliding osteotomy, single piece
|
Facility
OP
|
$11,370.00
|
|
|
Service Code
|
CPT 21121
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$11,370.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: IEHP Medi-Cal |
$6,516.76
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,516.76
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM [3423]
|
Facility
OP
|
$3.16
|
|
|
Service Code
|
NDC 0713-0683-15
|
| Hospital Charge Code |
1743212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Media |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM [3423]
|
Facility
IP
|
$3.16
|
|
|
Service Code
|
NDC 45802-056-35
|
| Hospital Charge Code |
1743212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM [3423]
|
Facility
IP
|
$3.16
|
|
|
Service Code
|
NDC 0713-0683-31
|
| Hospital Charge Code |
NDG3423
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM [3423]
|
Facility
OP
|
$3.16
|
|
|
Service Code
|
NDC 45802-056-35
|
| Hospital Charge Code |
1743212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Media |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM [3423]
|
Facility
IP
|
$3.16
|
|
|
Service Code
|
NDC 0713-0683-15
|
| Hospital Charge Code |
1743212
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM [3423]
|
Facility
OP
|
$3.16
|
|
|
Service Code
|
NDC 0713-0683-31
|
| Hospital Charge Code |
NDG3423
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: BCBS Transplant Transplant |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.69
|
| Rate for Payer: Dignity Health Media |
$2.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]
|
Facility
IP
|
$3.16
|
|
|
Service Code
|
NDC 52565-090-15
|
| Hospital Charge Code |
1743222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$2.21
|
| Rate for Payer: Cigna of CA PPO |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
| Rate for Payer: Networks By Design Commercial |
$2.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.69
|
|
|
GENTAMICIN 0.1 % TOPICAL OINTMENT [3424]
|
Facility
OP
|
$2.80
|
|
|
Service Code
|
NDC 52565-090-30
|
| Hospital Charge Code |
NDG3424
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: BCBS Transplant Transplant |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Media |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
