|
PEG 400-PROPYLENE GLYCOL 0.4 %-0.3 % EYE DROPS [35891]
|
Facility
OP
|
$0.62
|
|
|
Service Code
|
NDC 0065-0429-30
|
| Hospital Charge Code |
NDG35891C
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Media |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION [12519]
|
Facility
OP
|
$5,837.31
|
|
|
Service Code
|
NDC 72694-954-01
|
| Hospital Charge Code |
1755594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,400.95 |
| Max. Negotiated Rate |
$4,961.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,828.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,961.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,210.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,210.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,477.87
|
| Rate for Payer: BCBS Transplant Transplant |
$3,502.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,302.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,408.99
|
| Rate for Payer: Cash Price |
$2,626.79
|
| Rate for Payer: Cash Price |
$2,626.79
|
| Rate for Payer: Cigna of CA HMO |
$4,086.12
|
| Rate for Payer: Cigna of CA PPO |
$4,086.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,961.71
|
| Rate for Payer: Dignity Health Media |
$4,961.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,961.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,334.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,334.92
|
| Rate for Payer: Galaxy Health WC |
$4,961.71
|
| Rate for Payer: Global Benefits Group Commercial |
$3,502.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,377.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,893.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,224.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.95
|
| Rate for Payer: Multiplan Commercial |
$4,669.85
|
| Rate for Payer: Networks By Design Commercial |
$2,918.66
|
| Rate for Payer: Prime Health Services Commercial |
$4,961.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,502.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,502.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,918.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,918.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2,918.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,918.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,961.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,961.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4,961.71
|
|
|
PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION [12519]
|
Facility
IP
|
$5,837.31
|
|
|
Service Code
|
NDC 72694-954-01
|
| Hospital Charge Code |
1755594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,400.95 |
| Max. Negotiated Rate |
$4,961.71 |
| Rate for Payer: Blue Shield of California Commercial |
$4,156.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,988.70
|
| Rate for Payer: Cash Price |
$2,626.79
|
| Rate for Payer: Cigna of CA HMO |
$4,086.12
|
| Rate for Payer: Cigna of CA PPO |
$4,086.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,334.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,334.92
|
| Rate for Payer: Galaxy Health WC |
$4,961.71
|
| Rate for Payer: Global Benefits Group Commercial |
$3,502.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,893.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,224.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.95
|
| Rate for Payer: Multiplan Commercial |
$4,669.85
|
| Rate for Payer: Networks By Design Commercial |
$2,918.66
|
| Rate for Payer: Prime Health Services Commercial |
$4,961.71
|
|
|
PEGCETACOPLAN 1,080 MG/20 ML SUBCUTANEOUS SOLUTION [231891]
|
Facility
IP
|
$272.16
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG231891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Blue Shield of California Commercial |
$193.78
|
| Rate for Payer: Blue Shield of California EPN |
$139.35
|
| Rate for Payer: Cash Price |
$122.47
|
| Rate for Payer: Cigna of CA HMO |
$190.51
|
| Rate for Payer: Cigna of CA PPO |
$190.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.86
|
| Rate for Payer: Galaxy Health WC |
$231.34
|
| Rate for Payer: Global Benefits Group Commercial |
$163.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.32
|
| Rate for Payer: Multiplan Commercial |
$217.73
|
| Rate for Payer: Networks By Design Commercial |
$136.08
|
| Rate for Payer: Prime Health Services Commercial |
$231.34
|
|
|
PEGCETACOPLAN 1,080 MG/20 ML SUBCUTANEOUS SOLUTION [231891]
|
Facility
OP
|
$272.16
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG231891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$178.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$231.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$149.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.15
|
| Rate for Payer: BCBS Transplant Transplant |
$163.30
|
| Rate for Payer: Blue Shield of California Commercial |
$200.58
|
| Rate for Payer: Blue Shield of California EPN |
$158.94
|
| Rate for Payer: Cash Price |
$122.47
|
| Rate for Payer: Cash Price |
$122.47
|
| Rate for Payer: Cigna of CA HMO |
$190.51
|
| Rate for Payer: Cigna of CA PPO |
$190.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.34
|
| Rate for Payer: Dignity Health Media |
$231.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.86
|
| Rate for Payer: Galaxy Health WC |
$231.34
|
| Rate for Payer: Global Benefits Group Commercial |
$163.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$204.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.32
|
| Rate for Payer: Multiplan Commercial |
$217.73
|
| Rate for Payer: Networks By Design Commercial |
$136.08
|
| Rate for Payer: Prime Health Services Commercial |
$231.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.08
|
| Rate for Payer: United Healthcare All Other HMO |
$136.08
|
| Rate for Payer: United Healthcare HMO Rider |
$136.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.34
|
| Rate for Payer: Vantage Medical Group Senior |
$231.34
|
|
|
PEG-ELECTROLYTE SOLUTION 420 GRAM ORAL SOLUTION [110896]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 43386-050-19
|
| Hospital Charge Code |
NDG110896A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PEG-ELECTROLYTE SOLUTION 420 GRAM ORAL SOLUTION [110896]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 43386-050-19
|
| Hospital Charge Code |
NDG110896A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PEG-ELECTROLYTE SOLUTION 420 GRAM ORAL SOLUTION [110896]
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
NDC 52268-302-01
|
| Hospital Charge Code |
NDG110896A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
PEG-ELECTROLYTE SOLUTION 420 GRAM ORAL SOLUTION [110896]
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
NDC 52268-302-01
|
| Hospital Charge Code |
NDG110896A
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [208788]
|
Facility
OP
|
$12,835.98
|
|
|
Service Code
|
CPT J2506
|
| Hospital Charge Code |
ERX208788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$10,910.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$318.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.03
|
| Rate for Payer: BCBS Transplant Transplant |
$7,701.59
|
| Rate for Payer: Blue Shield of California Commercial |
$9,460.12
|
| Rate for Payer: Blue Shield of California EPN |
$7,496.21
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.02
|
| Rate for Payer: Dignity Health Media |
$50.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.68
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,626.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$83.11
|
| Rate for Payer: IEHP Medi-Cal |
$82.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$82.10
|
| Rate for Payer: IEHP Medicare Advantage |
$50.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,561.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,080.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.91
|
| Rate for Payer: Multiplan Commercial |
$10,268.78
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,701.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,701.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,417.99
|
| Rate for Payer: United Healthcare All Other HMO |
$6,417.99
|
| Rate for Payer: United Healthcare HMO Rider |
$6,417.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,417.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.75
|
| Rate for Payer: Vantage Medical Group Senior |
$50.68
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [208788]
|
Facility
IP
|
$12,835.98
|
|
|
Service Code
|
CPT J2506
|
| Hospital Charge Code |
ERX208788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,080.64 |
| Max. Negotiated Rate |
$10,910.58 |
| Rate for Payer: Blue Shield of California Commercial |
$9,139.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,572.02
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,134.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,134.39
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,561.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,890.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,080.64
|
| Rate for Payer: Multiplan Commercial |
$10,268.78
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [32267]
|
Facility
IP
|
$12,835.98
|
|
|
Service Code
|
CPT J2506
|
| Hospital Charge Code |
1720967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,080.64 |
| Max. Negotiated Rate |
$10,910.58 |
| Rate for Payer: Blue Shield of California Commercial |
$9,139.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,572.02
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,134.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,134.39
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,561.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,890.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,080.64
|
| Rate for Payer: Multiplan Commercial |
$10,268.78
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [32267]
|
Facility
OP
|
$12,835.98
|
|
|
Service Code
|
CPT J2506
|
| Hospital Charge Code |
1720967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$10,910.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$318.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$63.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.03
|
| Rate for Payer: BCBS Transplant Transplant |
$7,701.59
|
| Rate for Payer: Blue Shield of California Commercial |
$9,460.12
|
| Rate for Payer: Blue Shield of California EPN |
$7,496.21
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.02
|
| Rate for Payer: Dignity Health Media |
$50.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.68
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,626.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$83.11
|
| Rate for Payer: IEHP Medi-Cal |
$82.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$82.10
|
| Rate for Payer: IEHP Medicare Advantage |
$50.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,561.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,080.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.91
|
| Rate for Payer: Multiplan Commercial |
$10,268.78
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,701.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,701.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,417.99
|
| Rate for Payer: United Healthcare All Other HMO |
$6,417.99
|
| Rate for Payer: United Healthcare HMO Rider |
$6,417.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,417.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.75
|
| Rate for Payer: Vantage Medical Group Senior |
$50.68
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [225861]
|
Facility
IP
|
$7,851.06
|
|
|
Service Code
|
CPT Q5120
|
| Hospital Charge Code |
NDG225861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,884.25 |
| Max. Negotiated Rate |
$6,673.40 |
| Rate for Payer: Blue Shield of California Commercial |
$5,589.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,019.74
|
| Rate for Payer: Cash Price |
$3,532.98
|
| Rate for Payer: Cigna of CA HMO |
$5,495.74
|
| Rate for Payer: Cigna of CA PPO |
$5,495.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,140.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,140.42
|
| Rate for Payer: Galaxy Health WC |
$6,673.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,710.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,236.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,991.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,884.25
|
| Rate for Payer: Multiplan Commercial |
$6,280.85
|
| Rate for Payer: Networks By Design Commercial |
$3,925.53
|
| Rate for Payer: Prime Health Services Commercial |
$6,673.40
|
|
|
PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [225861]
|
Facility
OP
|
$7,851.06
|
|
|
Service Code
|
CPT Q5120
|
| Hospital Charge Code |
NDG225861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$346.76 |
| Max. Negotiated Rate |
$6,673.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,028.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$433.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$381.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$381.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.27
|
| Rate for Payer: BCBS Transplant Transplant |
$4,710.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5,786.23
|
| Rate for Payer: Blue Shield of California EPN |
$392.55
|
| Rate for Payer: Cash Price |
$3,532.98
|
| Rate for Payer: Cash Price |
$3,532.98
|
| Rate for Payer: Cigna of CA HMO |
$5,495.74
|
| Rate for Payer: Cigna of CA PPO |
$5,495.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.44
|
| Rate for Payer: Dignity Health Media |
$381.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$346.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$346.76
|
| Rate for Payer: Galaxy Health WC |
$6,673.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,710.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,888.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$568.68
|
| Rate for Payer: IEHP Medi-Cal |
$561.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$561.74
|
| Rate for Payer: IEHP Medicare Advantage |
$346.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,236.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,884.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$436.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$464.65
|
| Rate for Payer: Multiplan Commercial |
$6,280.85
|
| Rate for Payer: Networks By Design Commercial |
$3,925.53
|
| Rate for Payer: Prime Health Services Commercial |
$6,673.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,710.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,710.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,925.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,925.53
|
| Rate for Payer: United Healthcare HMO Rider |
$3,925.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,925.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$433.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.43
|
| Rate for Payer: Vantage Medical Group Senior |
$381.43
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [222174]
|
Facility
IP
|
$8,350.00
|
|
|
Service Code
|
CPT Q5108
|
| Hospital Charge Code |
NDG222174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,004.00 |
| Max. Negotiated Rate |
$7,097.50 |
| Rate for Payer: Blue Shield of California Commercial |
$5,945.20
|
| Rate for Payer: Blue Shield of California EPN |
$4,275.20
|
| Rate for Payer: Cash Price |
$3,757.50
|
| Rate for Payer: Cigna of CA HMO |
$5,845.00
|
| Rate for Payer: Cigna of CA PPO |
$5,845.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,340.00
|
| Rate for Payer: Galaxy Health WC |
$7,097.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,010.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,569.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,181.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.00
|
| Rate for Payer: Multiplan Commercial |
$6,680.00
|
| Rate for Payer: Networks By Design Commercial |
$4,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,097.50
|
|
|
PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [222174]
|
Facility
OP
|
$8,350.00
|
|
|
Service Code
|
CPT Q5108
|
| Hospital Charge Code |
NDG222174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.54 |
| Max. Negotiated Rate |
$7,097.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$770.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$134.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$741.60
|
| Rate for Payer: BCBS Transplant Transplant |
$5,010.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,153.95
|
| Rate for Payer: Blue Shield of California EPN |
$417.50
|
| Rate for Payer: Cash Price |
$3,757.50
|
| Rate for Payer: Cash Price |
$3,757.50
|
| Rate for Payer: Cigna of CA HMO |
$5,845.00
|
| Rate for Payer: Cigna of CA PPO |
$5,845.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.18
|
| Rate for Payer: Dignity Health Media |
$134.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$122.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.54
|
| Rate for Payer: Galaxy Health WC |
$7,097.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,010.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,262.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$200.97
|
| Rate for Payer: IEHP Medi-Cal |
$198.51
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$198.51
|
| Rate for Payer: IEHP Medicare Advantage |
$122.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,569.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.20
|
| Rate for Payer: Multiplan Commercial |
$6,680.00
|
| Rate for Payer: Networks By Design Commercial |
$4,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,097.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,010.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,010.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.79
|
| Rate for Payer: Vantage Medical Group Senior |
$134.79
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION [34034]
|
Facility
OP
|
$1,225.79
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.19 |
| Max. Negotiated Rate |
$1,041.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$804.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,041.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$674.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: BCBS Transplant Transplant |
$735.47
|
| Rate for Payer: Blue Shield of California Commercial |
$903.41
|
| Rate for Payer: Blue Shield of California EPN |
$715.86
|
| Rate for Payer: Cash Price |
$551.61
|
| Rate for Payer: Cash Price |
$551.61
|
| Rate for Payer: Cigna of CA HMO |
$858.05
|
| Rate for Payer: Cigna of CA PPO |
$858.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,041.92
|
| Rate for Payer: Dignity Health Media |
$1,041.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,041.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.32
|
| Rate for Payer: Galaxy Health WC |
$1,041.92
|
| Rate for Payer: Global Benefits Group Commercial |
$735.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$919.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.19
|
| Rate for Payer: Multiplan Commercial |
$980.63
|
| Rate for Payer: Networks By Design Commercial |
$612.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,041.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$735.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$735.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.90
|
| Rate for Payer: United Healthcare All Other HMO |
$612.90
|
| Rate for Payer: United Healthcare HMO Rider |
$612.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,041.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,041.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1,041.92
|
|
|
PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION [34034]
|
Facility
IP
|
$1,225.79
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1720953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.19 |
| Max. Negotiated Rate |
$1,041.92 |
| Rate for Payer: Blue Shield of California Commercial |
$872.76
|
| Rate for Payer: Blue Shield of California EPN |
$627.60
|
| Rate for Payer: Cash Price |
$551.61
|
| Rate for Payer: Cigna of CA HMO |
$858.05
|
| Rate for Payer: Cigna of CA PPO |
$858.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.32
|
| Rate for Payer: Galaxy Health WC |
$1,041.92
|
| Rate for Payer: Global Benefits Group Commercial |
$735.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$817.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.19
|
| Rate for Payer: Multiplan Commercial |
$980.63
|
| Rate for Payer: Networks By Design Commercial |
$612.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,041.92
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION [107664]
|
Facility
IP
|
$33,552.67
|
|
|
Service Code
|
CPT J2507
|
| Hospital Charge Code |
NDG107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,052.64 |
| Max. Negotiated Rate |
$28,519.77 |
| Rate for Payer: Blue Shield of California Commercial |
$23,889.50
|
| Rate for Payer: Blue Shield of California EPN |
$17,178.97
|
| Rate for Payer: Cash Price |
$15,098.70
|
| Rate for Payer: Cigna of CA HMO |
$23,486.87
|
| Rate for Payer: Cigna of CA PPO |
$23,486.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,421.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,421.07
|
| Rate for Payer: Galaxy Health WC |
$28,519.77
|
| Rate for Payer: Global Benefits Group Commercial |
$20,131.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,379.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,783.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,052.64
|
| Rate for Payer: Multiplan Commercial |
$26,842.14
|
| Rate for Payer: Networks By Design Commercial |
$16,776.34
|
| Rate for Payer: Prime Health Services Commercial |
$28,519.77
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION [107664]
|
Facility
OP
|
$33,552.67
|
|
|
Service Code
|
CPT J2507
|
| Hospital Charge Code |
NDG107664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.84 |
| Max. Negotiated Rate |
$28,519.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,202.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,213.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,708.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,708.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$612.84
|
| Rate for Payer: BCBS Transplant Transplant |
$20,131.60
|
| Rate for Payer: Blue Shield of California Commercial |
$24,728.32
|
| Rate for Payer: Blue Shield of California EPN |
$3,556.43
|
| Rate for Payer: Cash Price |
$15,098.70
|
| Rate for Payer: Cash Price |
$15,098.70
|
| Rate for Payer: Cigna of CA HMO |
$23,486.87
|
| Rate for Payer: Cigna of CA PPO |
$23,486.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,056.61
|
| Rate for Payer: Dignity Health Media |
$3,371.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,708.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,550.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,371.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,371.08
|
| Rate for Payer: Galaxy Health WC |
$28,519.77
|
| Rate for Payer: Global Benefits Group Commercial |
$20,131.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25,164.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,528.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,528.56
|
| Rate for Payer: IEHP Medi-Cal |
$5,461.14
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$5,461.14
|
| Rate for Payer: IEHP Medicare Advantage |
$3,371.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,379.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,413.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,371.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,052.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,247.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,517.24
|
| Rate for Payer: Multiplan Commercial |
$26,842.14
|
| Rate for Payer: Networks By Design Commercial |
$16,776.34
|
| Rate for Payer: Prime Health Services Commercial |
$28,519.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,131.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,776.34
|
| Rate for Payer: United Healthcare All Other HMO |
$16,776.34
|
| Rate for Payer: United Healthcare HMO Rider |
$16,776.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,776.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,056.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,708.18
|
| Rate for Payer: Vantage Medical Group Senior |
$3,371.08
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES
|
Facility
IP
|
$77,727.21
|
|
|
Service Code
|
APR-DRG 5104
|
| Min. Negotiated Rate |
$59,624.95 |
| Max. Negotiated Rate |
$77,727.21 |
| Rate for Payer: IEHP Medi-Cal |
$59,624.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77,727.21
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES
|
Facility
IP
|
$21,183.97
|
|
|
Service Code
|
APR-DRG 5101
|
| Min. Negotiated Rate |
$16,250.34 |
| Max. Negotiated Rate |
$21,183.97 |
| Rate for Payer: IEHP Medi-Cal |
$16,250.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,183.97
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES
|
Facility
IP
|
$37,781.78
|
|
|
Service Code
|
APR-DRG 5103
|
| Min. Negotiated Rate |
$28,982.61 |
| Max. Negotiated Rate |
$37,781.78 |
| Rate for Payer: IEHP Medi-Cal |
$28,982.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37,781.78
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES
|
Facility
IP
|
$24,789.43
|
|
|
Service Code
|
APR-DRG 5102
|
| Min. Negotiated Rate |
$19,016.10 |
| Max. Negotiated Rate |
$24,789.43 |
| Rate for Payer: IEHP Medi-Cal |
$19,016.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,789.43
|
|
