|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6438080706
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 5965136201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6438080706
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6068746811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
IP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$246.37 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Blue Shield of California Commercial |
$219.54
|
| Rate for Payer: Blue Shield of California EPN |
$137.96
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Central Health Plan Commercial |
$218.99
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.50
|
| Rate for Payer: EPIC Health Plan Senior |
$109.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.73
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.65
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
OP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$246.37 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.39
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Central Health Plan Commercial |
$218.99
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Senior |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.09
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: Prime Health Services Medicare |
$4.34
|
| Rate for Payer: Riverside University Health System MISP |
$4.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.73
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.09
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Blue Shield of California Commercial |
$56.57
|
| Rate for Payer: Blue Shield of California EPN |
$35.55
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Central Health Plan Commercial |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$49.38
|
| Rate for Payer: Cigna of CA PPO |
$49.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: EPIC Health Plan Senior |
$28.22
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Multiplan Commercial |
$52.91
|
| Rate for Payer: Networks By Design Commercial |
$35.27
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$25.77
|
| Rate for Payer: United Healthcare HMO Rider |
$25.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$1,860.96 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$175.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,860.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$454.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$567.15
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$365.42
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Central Health Plan Commercial |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$49.38
|
| Rate for Payer: Cigna of CA PPO |
$49.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.22
|
| Rate for Payer: EPIC Health Plan Senior |
$193.48
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$288.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.69
|
| Rate for Payer: Multiplan Commercial |
$52.91
|
| Rate for Payer: Networks By Design Commercial |
$35.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$175.89
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: Prime Health Services Medicare |
$186.44
|
| Rate for Payer: Riverside University Health System MISP |
$193.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$25.77
|
| Rate for Payer: United Healthcare HMO Rider |
$25.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.48
|
| Rate for Payer: Vantage Medical Group Senior |
$193.48
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California Commercial |
$12.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Blue Shield of California EPN |
$6.52
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$1,010.88 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$810.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$810.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$810.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,010.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,010.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,010.88
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Blue Shield of California EPN |
$62.08
|
| Rate for Payer: Blue Shield of California EPN |
$62.08
|
| Rate for Payer: Blue Shield of California EPN |
$62.08
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Riverside University Health System MISP |
$6.43
|
| Rate for Payer: Riverside University Health System MISP |
$4.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
OP
|
$62.45
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$56.20 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.84
|
| Rate for Payer: Blue Shield of California Commercial |
$39.59
|
| Rate for Payer: Blue Shield of California EPN |
$24.92
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Central Health Plan Commercial |
$49.96
|
| Rate for Payer: Cigna of CA HMO |
$43.72
|
| Rate for Payer: Cigna of CA PPO |
$43.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.98
|
| Rate for Payer: EPIC Health Plan Senior |
$24.98
|
| Rate for Payer: Galaxy Health WC |
$53.08
|
| Rate for Payer: Global Benefits Group Commercial |
$37.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.72
|
| Rate for Payer: Multiplan Commercial |
$46.84
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$53.08
|
| Rate for Payer: Riverside University Health System MISP |
$24.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$22.81
|
| Rate for Payer: United Healthcare HMO Rider |
$22.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
IP
|
$62.45
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$56.20 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$50.08
|
| Rate for Payer: Blue Shield of California EPN |
$31.47
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Central Health Plan Commercial |
$49.96
|
| Rate for Payer: Cigna of CA HMO |
$43.72
|
| Rate for Payer: Cigna of CA PPO |
$43.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.98
|
| Rate for Payer: EPIC Health Plan Senior |
$24.98
|
| Rate for Payer: Galaxy Health WC |
$53.08
|
| Rate for Payer: Global Benefits Group Commercial |
$37.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$46.84
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$53.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$22.81
|
| Rate for Payer: United Healthcare HMO Rider |
$22.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.45
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$325.91 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.91
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: Riverside University Health System MISP |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$325.91 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.91
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Central Health Plan Commercial |
$35.27
|
| Rate for Payer: Central Health Plan Commercial |
$55.73
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$22.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Riverside University Health System MISP |
$27.86
|
| Rate for Payer: Riverside University Health System MISP |
$17.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.14
|
| Rate for Payer: United Healthcare All Other HMO |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$24.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
IP
|
$69.66
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$62.69 |
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$55.87
|
| Rate for Payer: Blue Shield of California Commercial |
$35.36
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Central Health Plan Commercial |
$55.73
|
| Rate for Payer: Central Health Plan Commercial |
$35.27
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Networks By Design Commercial |
$22.05
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.14
|
| Rate for Payer: United Healthcare All Other HMO |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$24.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.81
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$325.91 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.91
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Central Health Plan Commercial |
$103.24
|
| Rate for Payer: Cigna of CA HMO |
$90.33
|
| Rate for Payer: Cigna of CA PPO |
$90.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Senior |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.33
|
| Rate for Payer: Multiplan Commercial |
$96.79
|
| Rate for Payer: Networks By Design Commercial |
$64.53
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: Riverside University Health System MISP |
$51.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.14
|
| Rate for Payer: United Healthcare HMO Rider |
$46.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.69
|
| Rate for Payer: Vantage Medical Group Senior |
$109.69
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$116.14 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Blue Shield of California Commercial |
$103.50
|
| Rate for Payer: Blue Shield of California EPN |
$65.04
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Central Health Plan Commercial |
$103.24
|
| Rate for Payer: Cigna of CA HMO |
$90.33
|
| Rate for Payer: Cigna of CA PPO |
$90.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Senior |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.81
|
| Rate for Payer: Multiplan Commercial |
$96.79
|
| Rate for Payer: Networks By Design Commercial |
$64.53
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.14
|
| Rate for Payer: United Healthcare HMO Rider |
$46.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.26
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$155.07 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Central Health Plan Commercial |
$3.64
|
| Rate for Payer: Central Health Plan Commercial |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$3.41
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Riverside University Health System MISP |
$0.79
|
| Rate for Payer: Riverside University Health System MISP |
$1.82
|
| Rate for Payer: Riverside University Health System MISP |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Central Health Plan Commercial |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$3.64
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.41
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$155.07 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.07
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Central Health Plan Commercial |
$4.16
|
| Rate for Payer: Central Health Plan Commercial |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.42
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.12
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Networks By Design Commercial |
$3.38
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.42
|
| Rate for Payer: Riverside University Health System MISP |
$2.08
|
| Rate for Payer: Riverside University Health System MISP |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.42
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Central Health Plan Commercial |
$4.20
|
| Rate for Payer: Central Health Plan Commercial |
$4.16
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.42
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.12
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.38
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.42
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION [241932]
|
Facility
|
IP
|
$12,772.56
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,554.51 |
| Max. Negotiated Rate |
$11,495.30 |
| Rate for Payer: Adventist Health Commercial |
$2,554.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10,243.59
|
| Rate for Payer: Blue Shield of California EPN |
$6,437.37
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,218.05
|
| Rate for Payer: Cigna of CA HMO |
$8,940.79
|
| Rate for Payer: Cigna of CA PPO |
$8,940.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,940.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,109.02
|
| Rate for Payer: EPIC Health Plan Senior |
$5,109.02
|
| Rate for Payer: Galaxy Health WC |
$10,856.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7,663.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,495.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,110.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,535.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.51
|
| Rate for Payer: Multiplan Commercial |
$9,579.42
|
| Rate for Payer: Networks By Design Commercial |
$6,386.28
|
| Rate for Payer: Prime Health Services Commercial |
$10,856.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,793.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4,665.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4,564.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,183.01
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION [241932]
|
Facility
|
OP
|
$12,772.56
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$11,495.30 |
| Rate for Payer: Adventist Health Commercial |
$2,554.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$59.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.82
|
| Rate for Payer: Blue Shield of California Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California EPN |
$63.09
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,218.05
|
| Rate for Payer: Cigna of CA HMO |
$8,940.79
|
| Rate for Payer: Cigna of CA PPO |
$8,940.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,940.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.22
|
| Rate for Payer: EPIC Health Plan Senior |
$65.48
|
| Rate for Payer: Galaxy Health WC |
$10,856.68
|
| Rate for Payer: Global Benefits Group Commercial |
$7,663.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,495.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,110.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.77
|
| Rate for Payer: Multiplan Commercial |
$9,579.42
|
| Rate for Payer: Networks By Design Commercial |
$6,386.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$59.53
|
| Rate for Payer: Prime Health Services Commercial |
$10,856.68
|
| Rate for Payer: Prime Health Services Medicare |
$63.10
|
| Rate for Payer: Riverside University Health System MISP |
$65.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,663.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,663.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,793.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4,665.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4,564.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,183.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$59.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Vantage Medical Group Senior |
$65.48
|
|
|
IMETELSTAT 47 MG INTRAVENOUS SOLUTION [241930]
|
Facility
|
OP
|
$3,193.14
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$2,873.83 |
| Rate for Payer: Adventist Health Commercial |
$638.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$59.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.82
|
| Rate for Payer: Blue Shield of California Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California EPN |
$63.09
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Central Health Plan Commercial |
$2,554.51
|
| Rate for Payer: Cigna of CA HMO |
$2,235.20
|
| Rate for Payer: Cigna of CA PPO |
$2,235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.22
|
| Rate for Payer: EPIC Health Plan Senior |
$65.48
|
| Rate for Payer: Galaxy Health WC |
$2,714.17
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,873.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.77
|
| Rate for Payer: Multiplan Commercial |
$2,394.86
|
| Rate for Payer: Networks By Design Commercial |
$1,596.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$59.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.17
|
| Rate for Payer: Prime Health Services Medicare |
$63.10
|
| Rate for Payer: Riverside University Health System MISP |
$65.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$59.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Vantage Medical Group Senior |
$65.48
|
|
