|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
IP
|
$233.26
|
|
|
Service Code
|
CPT J9301
|
| Hospital Charge Code |
NDG204196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.98 |
| Max. Negotiated Rate |
$198.27 |
| Rate for Payer: Blue Shield of California Commercial |
$166.08
|
| Rate for Payer: Blue Shield of California EPN |
$119.43
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cigna of CA HMO |
$163.28
|
| Rate for Payer: Cigna of CA PPO |
$163.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.30
|
| Rate for Payer: Galaxy Health WC |
$198.27
|
| Rate for Payer: Global Benefits Group Commercial |
$139.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.98
|
| Rate for Payer: Multiplan Commercial |
$186.61
|
| Rate for Payer: Networks By Design Commercial |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$198.27
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [204196]
|
Facility
OP
|
$233.26
|
|
|
Service Code
|
CPT J9301
|
| Hospital Charge Code |
NDG204196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.98 |
| Max. Negotiated Rate |
$198.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$87.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.97
|
| Rate for Payer: BCBS Transplant Transplant |
$139.96
|
| Rate for Payer: Blue Shield of California Commercial |
$171.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cash Price |
$104.97
|
| Rate for Payer: Cigna of CA HMO |
$163.28
|
| Rate for Payer: Cigna of CA PPO |
$163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.51
|
| Rate for Payer: Dignity Health Media |
$70.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$70.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.34
|
| Rate for Payer: Galaxy Health WC |
$198.27
|
| Rate for Payer: Global Benefits Group Commercial |
$139.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$174.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.36
|
| Rate for Payer: Heritage Provider Network Transplant |
$115.36
|
| Rate for Payer: IEHP Medi-Cal |
$113.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$113.95
|
| Rate for Payer: IEHP Medicare Advantage |
$70.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.26
|
| Rate for Payer: Multiplan Commercial |
$186.61
|
| Rate for Payer: Networks By Design Commercial |
$116.63
|
| Rate for Payer: Prime Health Services Commercial |
$198.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.63
|
| Rate for Payer: United Healthcare All Other HMO |
$116.63
|
| Rate for Payer: United Healthcare HMO Rider |
$116.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.38
|
| Rate for Payer: Vantage Medical Group Senior |
$70.34
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [216963]
|
Facility
OP
|
$2,253.07
|
|
|
Service Code
|
CPT J2350
|
| Hospital Charge Code |
NDG216963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$1,915.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$375.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.50
|
| Rate for Payer: BCBS Transplant Transplant |
$1,351.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,660.51
|
| Rate for Payer: Blue Shield of California EPN |
$65.00
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cigna of CA HMO |
$1,577.15
|
| Rate for Payer: Cigna of CA PPO |
$1,577.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.63
|
| Rate for Payer: Dignity Health Media |
$59.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.75
|
| Rate for Payer: Galaxy Health WC |
$1,915.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,689.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.99
|
| Rate for Payer: IEHP Medi-Cal |
$96.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$96.80
|
| Rate for Payer: IEHP Medicare Advantage |
$59.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.07
|
| Rate for Payer: Multiplan Commercial |
$1,802.46
|
| Rate for Payer: Networks By Design Commercial |
$1,126.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,351.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,351.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,126.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,126.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,126.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,126.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.73
|
| Rate for Payer: Vantage Medical Group Senior |
$59.75
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [216963]
|
Facility
IP
|
$2,253.07
|
|
|
Service Code
|
CPT J2350
|
| Hospital Charge Code |
NDG216963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$540.74 |
| Max. Negotiated Rate |
$1,915.11 |
| Rate for Payer: Blue Shield of California Commercial |
$1,604.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,153.57
|
| Rate for Payer: Cash Price |
$1,013.88
|
| Rate for Payer: Cigna of CA HMO |
$1,577.15
|
| Rate for Payer: Cigna of CA PPO |
$1,577.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$901.23
|
| Rate for Payer: Galaxy Health WC |
$1,915.11
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,502.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.74
|
| Rate for Payer: Multiplan Commercial |
$1,802.46
|
| Rate for Payer: Networks By Design Commercial |
$1,126.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,915.11
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
OP
|
$119.25
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
NDG91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$101.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: BCBS Transplant Transplant |
$71.55
|
| Rate for Payer: Blue Shield of California Commercial |
$87.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.36
|
| Rate for Payer: Dignity Health Media |
$101.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$89.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.62
|
| Rate for Payer: United Healthcare All Other HMO |
$59.62
|
| Rate for Payer: United Healthcare HMO Rider |
$59.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.36
|
| Rate for Payer: Vantage Medical Group Senior |
$101.36
|
|
|
OCTREOTIDE ACETATE 1,000 MCG/ML INJECTION SOLUTION [91282]
|
Facility
IP
|
$119.25
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
NDG91282
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$101.36 |
| Rate for Payer: Blue Shield of California Commercial |
$84.91
|
| Rate for Payer: Blue Shield of California EPN |
$61.06
|
| Rate for Payer: Cash Price |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.70
|
| Rate for Payer: Galaxy Health WC |
$101.36
|
| Rate for Payer: Global Benefits Group Commercial |
$71.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$95.40
|
| Rate for Payer: Networks By Design Commercial |
$59.62
|
| Rate for Payer: Prime Health Services Commercial |
$101.36
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
IP
|
$7.80
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: Blue Shield of California Commercial |
$5.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [91279]
|
Facility
OP
|
$7.80
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: BCBS Transplant Transplant |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5.75
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.63
|
| Rate for Payer: Dignity Health Media |
$6.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.24
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]
|
Facility
OP
|
$12.90
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA HMO |
$9.03
|
| Rate for Payer: Cigna of CA HMO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$9.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: BCBS Transplant Transplant |
$35.78
|
| Rate for Payer: BCBS Transplant Transplant |
$25.20
|
| Rate for Payer: BCBS Transplant Transplant |
$7.74
|
| Rate for Payer: Blue Shield of California Commercial |
$30.95
|
| Rate for Payer: Blue Shield of California Commercial |
$43.95
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.69
|
| Rate for Payer: Dignity Health Media |
$10.96
|
| Rate for Payer: Dignity Health Media |
$50.69
|
| Rate for Payer: Dignity Health Media |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$10.96
|
| Rate for Payer: Galaxy Health WC |
$50.69
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$35.78
|
| Rate for Payer: Global Benefits Group Commercial |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.31
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Networks By Design Commercial |
$29.82
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$10.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.45
|
| Rate for Payer: United Healthcare All Other HMO |
$29.82
|
| Rate for Payer: United Healthcare All Other HMO |
$21.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.45
|
| Rate for Payer: United Healthcare HMO Rider |
$6.45
|
| Rate for Payer: United Healthcare HMO Rider |
$21.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.69
|
| Rate for Payer: Vantage Medical Group Senior |
$10.96
|
| Rate for Payer: Vantage Medical Group Senior |
$50.69
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION [91281]
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Blue Shield of California Commercial |
$29.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.18
|
| Rate for Payer: Blue Shield of California Commercial |
$42.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.60
|
| Rate for Payer: Blue Shield of California EPN |
$21.50
|
| Rate for Payer: Blue Shield of California EPN |
$30.53
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cigna of CA HMO |
$41.74
|
| Rate for Payer: Cigna of CA HMO |
$9.03
|
| Rate for Payer: Cigna of CA HMO |
$29.40
|
| Rate for Payer: Cigna of CA PPO |
$41.74
|
| Rate for Payer: Cigna of CA PPO |
$9.03
|
| Rate for Payer: Cigna of CA PPO |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$50.69
|
| Rate for Payer: Galaxy Health WC |
$10.96
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$35.78
|
| Rate for Payer: Global Benefits Group Commercial |
$7.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$47.70
|
| Rate for Payer: Multiplan Commercial |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$29.82
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$10.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$50.69
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]
|
Facility
OP
|
$5.40
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.53
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.23
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION [91278]
|
Facility
IP
|
$5.40
|
|
|
Service Code
|
CPT J2354
|
| Hospital Charge Code |
1720586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
|
|
OCTREOTIDE,MICROSPHERES 20 MG INTRAMUSCULAR WRAP, LONG-ACTING RELEASE [40824435]
|
Facility
IP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,277.87 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Blue Shield of California Commercial |
$3,791.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,726.12
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,129.78
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
|
|
OCTREOTIDE,MICROSPHERES 20 MG INTRAMUSCULAR WRAP, LONG-ACTING RELEASE [40824435]
|
Facility
OP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: BCBS Transplant Transplant |
$3,194.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,924.12
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,993.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: IEHP Medi-Cal |
$341.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$341.54
|
| Rate for Payer: IEHP Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,194.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,194.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,662.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,662.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2,662.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,662.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG INTRAMUSCULR WRAP, LONG-ACTING RELEASE [40824436]
|
Facility
OP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: BCBS Transplant Transplant |
$4,783.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,876.08
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,979.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: IEHP Medi-Cal |
$341.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$341.54
|
| Rate for Payer: IEHP Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG INTRAMUSCULR WRAP, LONG-ACTING RELEASE [40824436]
|
Facility
IP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX24436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,913.51 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Blue Shield of California Commercial |
$5,676.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,082.16
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,189.19
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204871]
|
Facility
OP
|
$4,063.93
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$3,454.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: BCBS Transplant Transplant |
$2,438.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,995.12
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$1,828.77
|
| Rate for Payer: Cash Price |
$1,828.77
|
| Rate for Payer: Cigna of CA HMO |
$2,844.75
|
| Rate for Payer: Cigna of CA PPO |
$2,844.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$3,454.34
|
| Rate for Payer: Global Benefits Group Commercial |
$2,438.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,047.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: IEHP Medi-Cal |
$341.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$341.54
|
| Rate for Payer: IEHP Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,710.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$3,251.14
|
| Rate for Payer: Networks By Design Commercial |
$2,031.96
|
| Rate for Payer: Prime Health Services Commercial |
$3,454.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,438.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,438.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,031.96
|
| Rate for Payer: United Healthcare All Other HMO |
$2,031.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,031.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,031.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204871]
|
Facility
IP
|
$4,063.93
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$975.34 |
| Max. Negotiated Rate |
$3,454.34 |
| Rate for Payer: Blue Shield of California Commercial |
$2,893.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.73
|
| Rate for Payer: Cash Price |
$1,828.77
|
| Rate for Payer: Cigna of CA HMO |
$2,844.75
|
| Rate for Payer: Cigna of CA PPO |
$2,844.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,625.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,625.57
|
| Rate for Payer: Galaxy Health WC |
$3,454.34
|
| Rate for Payer: Global Benefits Group Commercial |
$2,438.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,710.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.34
|
| Rate for Payer: Multiplan Commercial |
$3,251.14
|
| Rate for Payer: Networks By Design Commercial |
$2,031.96
|
| Rate for Payer: Prime Health Services Commercial |
$3,454.34
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204610]
|
Facility
IP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
1720927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,277.87 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Blue Shield of California Commercial |
$3,791.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,726.12
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,129.78
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204610]
|
Facility
OP
|
$5,324.45
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
1720927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$4,525.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: BCBS Transplant Transplant |
$3,194.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,924.12
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cash Price |
$2,396.00
|
| Rate for Payer: Cigna of CA HMO |
$3,727.12
|
| Rate for Payer: Cigna of CA PPO |
$3,727.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$4,525.78
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,993.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: IEHP Medi-Cal |
$341.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$341.54
|
| Rate for Payer: IEHP Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,277.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$4,259.56
|
| Rate for Payer: Networks By Design Commercial |
$2,662.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,194.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,194.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,662.22
|
| Rate for Payer: United Healthcare All Other HMO |
$2,662.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2,662.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,662.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204612]
|
Facility
IP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,913.51 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Blue Shield of California Commercial |
$5,676.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,082.16
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,189.19
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [204612]
|
Facility
OP
|
$7,972.97
|
|
|
Service Code
|
CPT J2353
|
| Hospital Charge Code |
ERX204612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$6,777.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$231.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.38
|
| Rate for Payer: BCBS Transplant Transplant |
$4,783.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,876.08
|
| Rate for Payer: Blue Shield of California EPN |
$255.88
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cash Price |
$3,587.84
|
| Rate for Payer: Cigna of CA HMO |
$5,581.08
|
| Rate for Payer: Cigna of CA PPO |
$5,581.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$316.24
|
| Rate for Payer: Dignity Health Media |
$210.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$210.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.83
|
| Rate for Payer: Galaxy Health WC |
$6,777.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,979.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$345.76
|
| Rate for Payer: IEHP Medi-Cal |
$341.54
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$341.54
|
| Rate for Payer: IEHP Medicare Advantage |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.51
|
| Rate for Payer: Multiplan Commercial |
$6,378.38
|
| Rate for Payer: Networks By Design Commercial |
$3,986.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$316.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.91
|
| Rate for Payer: Vantage Medical Group Senior |
$210.83
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
OP
|
$30.86
|
|
|
Service Code
|
NDC 24208-410-05
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$26.23 |
| Rate for Payer: BCBS Transplant Transplant |
$18.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.39
|
| Rate for Payer: Blue Shield of California Commercial |
$22.74
|
| Rate for Payer: Blue Shield of California EPN |
$18.02
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Cigna of CA HMO |
$21.60
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.23
|
| Rate for Payer: Dignity Health Media |
$26.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.34
|
| Rate for Payer: Galaxy Health WC |
$26.23
|
| Rate for Payer: Global Benefits Group Commercial |
$18.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$24.69
|
| Rate for Payer: Networks By Design Commercial |
$20.06
|
| Rate for Payer: Prime Health Services Commercial |
$26.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.23
|
| Rate for Payer: Vantage Medical Group Senior |
$26.23
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
IP
|
$30.86
|
|
|
Service Code
|
NDC 24208-410-05
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$26.23 |
| Rate for Payer: Blue Shield of California Commercial |
$21.97
|
| Rate for Payer: Blue Shield of California EPN |
$15.80
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Cigna of CA HMO |
$21.60
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.34
|
| Rate for Payer: Galaxy Health WC |
$26.23
|
| Rate for Payer: Global Benefits Group Commercial |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$24.69
|
| Rate for Payer: Networks By Design Commercial |
$20.06
|
| Rate for Payer: Prime Health Services Commercial |
$26.23
|
|
|
OFLOXACIN 0.3 % EAR DROPS [22257]
|
Facility
IP
|
$15.60
|
|
|
Service Code
|
NDC 60505-0363-1
|
| Hospital Charge Code |
1740311
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Blue Shield of California Commercial |
$11.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.99
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$10.92
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.26
|
| Rate for Payer: Global Benefits Group Commercial |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$13.26
|
|
