|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
IP
|
$273.74
|
|
|
Service Code
|
CPT J1741
|
| Hospital Charge Code |
1721169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Blue Shield of California Commercial |
$194.90
|
| Rate for Payer: Blue Shield of California EPN |
$140.15
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$218.99
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.36
|
| Rate for Payer: United Healthcare All Other HMO |
$100.96
|
| Rate for Payer: United Healthcare HMO Rider |
$98.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.33
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
OP
|
$273.74
|
|
|
Service Code
|
CPT J1741
|
| Hospital Charge Code |
1721169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.60
|
| Rate for Payer: Blue Distinction Transplant |
$164.24
|
| Rate for Payer: Blue Shield of California Commercial |
$201.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.59
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.68
|
| Rate for Payer: Dignity Health Media |
$232.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$218.99
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.87
|
| Rate for Payer: United Healthcare All Other HMO |
$136.87
|
| Rate for Payer: United Healthcare HMO Rider |
$136.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.68
|
| Rate for Payer: Vantage Medical Group Senior |
$232.68
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
OP
|
$65.86
|
|
|
Service Code
|
CPT J1742
|
| Hospital Charge Code |
1722011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$1,850.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,850.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$209.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.47
|
| Rate for Payer: Blue Distinction Transplant |
$39.52
|
| Rate for Payer: Blue Shield of California Commercial |
$48.54
|
| Rate for Payer: Blue Shield of California EPN |
$357.96
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$46.10
|
| Rate for Payer: Cigna of CA PPO |
$46.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.37
|
| Rate for Payer: Dignity Health Media |
$190.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$190.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$190.24
|
| Rate for Payer: Galaxy Health WC |
$55.98
|
| Rate for Payer: Global Benefits Group Commercial |
$39.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$308.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$308.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$190.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$239.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$254.93
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$32.93
|
| Rate for Payer: Prime Health Services Commercial |
$55.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.93
|
| Rate for Payer: United Healthcare All Other HMO |
$32.93
|
| Rate for Payer: United Healthcare HMO Rider |
$32.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.27
|
| Rate for Payer: Vantage Medical Group Senior |
$190.24
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
IP
|
$65.86
|
|
|
Service Code
|
CPT J1742
|
| Hospital Charge Code |
1722011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$55.98 |
| Rate for Payer: Blue Shield of California Commercial |
$46.89
|
| Rate for Payer: Blue Shield of California EPN |
$33.72
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna of CA HMO |
$46.10
|
| Rate for Payer: Cigna of CA PPO |
$46.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.34
|
| Rate for Payer: Galaxy Health WC |
$55.98
|
| Rate for Payer: Global Benefits Group Commercial |
$39.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.81
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$32.93
|
| Rate for Payer: Prime Health Services Commercial |
$55.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.87
|
| Rate for Payer: United Healthcare All Other HMO |
$24.29
|
| Rate for Payer: United Healthcare HMO Rider |
$23.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.73
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$12.42
|
|
|
Service Code
|
CPT J9211
|
| Hospital Charge Code |
1755541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.58
|
| Rate for Payer: United Healthcare HMO Rider |
$4.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
CPT J9211
|
| Hospital Charge Code |
NDG22144A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$872.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.43
|
| Rate for Payer: Blue Distinction Transplant |
$7.76
|
| Rate for Payer: Blue Shield of California Commercial |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$61.17
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Media |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO |
$6.47
|
| Rate for Payer: United Healthcare HMO Rider |
$6.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.42
|
|
|
Service Code
|
CPT J9211
|
| Hospital Charge Code |
1755541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$872.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.43
|
| Rate for Payer: Blue Distinction Transplant |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$61.17
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Media |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.97
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.21
|
| Rate for Payer: United Healthcare All Other HMO |
$6.21
|
| Rate for Payer: United Healthcare HMO Rider |
$6.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$12.94
|
|
|
Service Code
|
CPT J9211
|
| Hospital Charge Code |
NDG22144A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9.21
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.77
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.27
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
CPT J9211
|
| Hospital Charge Code |
NDG22144B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$13.66 |
| Rate for Payer: Blue Shield of California Commercial |
$11.44
|
| Rate for Payer: Blue Shield of California EPN |
$8.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other HMO |
$5.93
|
| Rate for Payer: United Healthcare HMO Rider |
$5.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.30
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$16.07
|
|
|
Service Code
|
CPT J9211
|
| Hospital Charge Code |
NDG22144B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$872.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.43
|
| Rate for Payer: Blue Distinction Transplant |
$9.64
|
| Rate for Payer: Blue Shield of California Commercial |
$11.84
|
| Rate for Payer: Blue Shield of California EPN |
$61.17
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Media |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.04
|
| Rate for Payer: United Healthcare All Other HMO |
$8.04
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
OP
|
$56.61
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
NDG211698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.14
|
| Rate for Payer: Blue Distinction Transplant |
$33.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.72
|
| Rate for Payer: Blue Shield of California EPN |
$33.06
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.63
|
| Rate for Payer: Cigna of CA PPO |
$39.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.12
|
| Rate for Payer: Dignity Health Media |
$48.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.12
|
| Rate for Payer: Global Benefits Group Commercial |
$33.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.59
|
| Rate for Payer: Multiplan Commercial |
$45.29
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$48.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.30
|
| Rate for Payer: United Healthcare All Other HMO |
$28.30
|
| Rate for Payer: United Healthcare HMO Rider |
$28.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.12
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
IP
|
$56.61
|
|
|
Service Code
|
CPT J3590
|
| Hospital Charge Code |
NDG211698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Blue Shield of California Commercial |
$40.31
|
| Rate for Payer: Blue Shield of California EPN |
$28.98
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cigna of CA HMO |
$39.63
|
| Rate for Payer: Cigna of CA PPO |
$39.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.64
|
| Rate for Payer: Galaxy Health WC |
$48.12
|
| Rate for Payer: Global Benefits Group Commercial |
$33.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.59
|
| Rate for Payer: Multiplan Commercial |
$45.29
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$48.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.38
|
| Rate for Payer: United Healthcare All Other HMO |
$20.88
|
| Rate for Payer: United Healthcare HMO Rider |
$20.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.68
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: Blue Distinction Transplant |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Media |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: Blue Distinction Transplant |
$26.45
|
| Rate for Payer: Blue Distinction Transplant |
$41.80
|
| Rate for Payer: Blue Shield of California Commercial |
$32.49
|
| Rate for Payer: Blue Shield of California Commercial |
$51.34
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Media |
$59.21
|
| Rate for Payer: Dignity Health Media |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$55.73
|
| Rate for Payer: Multiplan Commercial |
$35.27
|
| Rate for Payer: Networks By Design Commercial |
$22.04
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.83
|
| Rate for Payer: United Healthcare All Other HMO |
$34.83
|
| Rate for Payer: United Healthcare All Other HMO |
$22.04
|
| Rate for Payer: United Healthcare HMO Rider |
$34.83
|
| Rate for Payer: United Healthcare HMO Rider |
$22.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
IP
|
$44.09
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$37.48 |
| Rate for Payer: Blue Shield of California Commercial |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$49.60
|
| Rate for Payer: Blue Shield of California EPN |
$22.57
|
| Rate for Payer: Blue Shield of California EPN |
$35.67
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.72
|
| Rate for Payer: Multiplan Commercial |
$35.27
|
| Rate for Payer: Multiplan Commercial |
$55.73
|
| Rate for Payer: Networks By Design Commercial |
$22.04
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.30
|
| Rate for Payer: United Healthcare All Other HMO |
$16.26
|
| Rate for Payer: United Healthcare All Other HMO |
$25.69
|
| Rate for Payer: United Healthcare HMO Rider |
$15.91
|
| Rate for Payer: United Healthcare HMO Rider |
$25.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.99
|
|
|
IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION [87926]
|
Facility
|
OP
|
$2.15
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: Blue Distinction Transplant |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.83
|
| Rate for Payer: Dignity Health Media |
$1.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: Vantage Medical Group Senior |
$1.83
|
|
|
IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION [87926]
|
Facility
|
IP
|
$2.15
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
NDG87926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.83
|
| Rate for Payer: Global Benefits Group Commercial |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.72
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$109.69 |
| Rate for Payer: Blue Shield of California Commercial |
$91.88
|
| Rate for Payer: Blue Shield of California EPN |
$66.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO |
$90.34
|
| Rate for Payer: Cigna of CA PPO |
$90.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.97
|
| Rate for Payer: Multiplan Commercial |
$103.24
|
| Rate for Payer: Networks By Design Commercial |
$64.52
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.73
|
| Rate for Payer: United Healthcare All Other HMO |
$47.59
|
| Rate for Payer: United Healthcare HMO Rider |
$46.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.59
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
CPT J9208
|
| Hospital Charge Code |
1755703
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$281.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.28
|
| Rate for Payer: Blue Distinction Transplant |
$77.43
|
| Rate for Payer: Blue Shield of California Commercial |
$95.11
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO |
$90.34
|
| Rate for Payer: Cigna of CA PPO |
$90.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.69
|
| Rate for Payer: Dignity Health Media |
$109.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.97
|
| Rate for Payer: Multiplan Commercial |
$103.24
|
| Rate for Payer: Networks By Design Commercial |
$64.52
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.52
|
| Rate for Payer: United Healthcare All Other HMO |
$64.52
|
| Rate for Payer: United Healthcare HMO Rider |
$64.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.69
|
| Rate for Payer: Vantage Medical Group Senior |
$109.69
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-30
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: Blue Distinction Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-00
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: Blue Distinction Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-00
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.76
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
IP
|
$161.64
|
|
|
Service Code
|
NDC 66215-302-30
|
| Hospital Charge Code |
1744129
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| Rate for Payer: Blue Shield of California EPN |
$82.76
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
OP
|
$161.64
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
1744134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.31
|
| Rate for Payer: Blue Distinction Transplant |
$96.98
|
| Rate for Payer: Blue Shield of California Commercial |
$119.13
|
| Rate for Payer: Blue Shield of California EPN |
$94.40
|
| Rate for Payer: Cash Price |
$72.74
|
| Rate for Payer: Cigna of CA HMO |
$113.15
|
| Rate for Payer: Cigna of CA PPO |
$113.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Media |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.66
|
| Rate for Payer: Galaxy Health WC |
$137.39
|
| Rate for Payer: Global Benefits Group Commercial |
$96.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.79
|
| Rate for Payer: Multiplan Commercial |
$129.31
|
| Rate for Payer: Networks By Design Commercial |
$105.07
|
| Rate for Payer: Prime Health Services Commercial |
$137.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.82
|
| Rate for Payer: United Healthcare All Other HMO |
$80.82
|
| Rate for Payer: United Healthcare HMO Rider |
$80.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
