|
LEUCOVORIN CALCIUM 5 MG TABLET [4398]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 0054449613
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$0.94
|
| Rate for Payer: Cigna of CA PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.14
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET [4398]
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 5074218130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET [4398]
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
NDC 0054849619
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.32
|
| Rate for Payer: Cigna of CA PPO |
$1.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET [4398]
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 5074218130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Senior |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET [4398]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 6931518403
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$0.94
|
| Rate for Payer: Cigna of CA PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Vantage Medical Group Senior |
$1.14
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET [4398]
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
NDC 0054849619
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.32
|
| Rate for Payer: Cigna of CA PPO |
$1.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT [10390]
|
Facility
|
OP
|
$4,956.43
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$889.07 |
| Max. Negotiated Rate |
$10,350.93 |
| Rate for Payer: Adventist Health Commercial |
$991.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,841.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,350.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,264.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,058.41
|
| Rate for Payer: Cash Price |
$2,230.39
|
| Rate for Payer: Cash Price |
$2,230.39
|
| Rate for Payer: Central Health Plan Commercial |
$3,965.14
|
| Rate for Payer: Cigna of CA HMO |
$3,469.50
|
| Rate for Payer: Cigna of CA PPO |
$3,469.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,469.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.39
|
| Rate for Payer: Galaxy Health WC |
$4,212.97
|
| Rate for Payer: Global Benefits Group Commercial |
$2,973.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,460.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,019.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,841.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,147.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,359.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,577.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,467.29
|
| Rate for Payer: Multiplan Commercial |
$3,717.32
|
| Rate for Payer: Networks By Design Commercial |
$2,478.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Prime Health Services Commercial |
$4,212.97
|
| Rate for Payer: Prime Health Services Medicare |
$1,951.74
|
| Rate for Payer: Riverside University Health System MISP |
$2,025.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,973.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,973.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,860.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,810.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,771.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,623.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,841.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.39
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT [10390]
|
Facility
|
IP
|
$4,956.43
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$991.29 |
| Max. Negotiated Rate |
$4,460.79 |
| Rate for Payer: Adventist Health Commercial |
$991.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,975.06
|
| Rate for Payer: Blue Shield of California EPN |
$2,498.04
|
| Rate for Payer: Cash Price |
$2,230.39
|
| Rate for Payer: Central Health Plan Commercial |
$3,965.14
|
| Rate for Payer: Cigna of CA HMO |
$3,469.50
|
| Rate for Payer: Cigna of CA PPO |
$3,469.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,469.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,982.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1,982.57
|
| Rate for Payer: Galaxy Health WC |
$4,212.97
|
| Rate for Payer: Global Benefits Group Commercial |
$2,973.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,460.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,147.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,924.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.29
|
| Rate for Payer: Multiplan Commercial |
$3,717.32
|
| Rate for Payer: Networks By Design Commercial |
$2,478.22
|
| Rate for Payer: Prime Health Services Commercial |
$4,212.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,860.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1,810.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,771.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,623.23
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT [14135]
|
Facility
|
OP
|
$855.36
|
|
|
Service Code
|
HCPCS J9218
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Adventist Health Commercial |
$171.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$641.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.74
|
| Rate for Payer: Blue Shield of California Commercial |
$66.95
|
| Rate for Payer: Blue Shield of California EPN |
$60.86
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.14
|
| Rate for Payer: EPIC Health Plan Senior |
$342.14
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$504.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$598.75
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
| Rate for Payer: Riverside University Health System MISP |
$342.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.02
|
| Rate for Payer: United Healthcare All Other HMO |
$312.46
|
| Rate for Payer: United Healthcare HMO Rider |
$305.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.06
|
| Rate for Payer: Vantage Medical Group Senior |
$727.06
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT [14135]
|
Facility
|
IP
|
$855.36
|
|
|
Service Code
|
HCPCS J9218
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.07 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Adventist Health Commercial |
$171.07
|
| Rate for Payer: Blue Shield of California Commercial |
$686.00
|
| Rate for Payer: Blue Shield of California EPN |
$431.10
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.14
|
| Rate for Payer: EPIC Health Plan Senior |
$342.14
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$504.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.02
|
| Rate for Payer: United Healthcare All Other HMO |
$312.46
|
| Rate for Payer: United Healthcare HMO Rider |
$305.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.13
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT. [40814135]
|
Facility
|
IP
|
$855.36
|
|
|
Service Code
|
HCPCS J9218
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.07 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Adventist Health Commercial |
$171.07
|
| Rate for Payer: Blue Shield of California Commercial |
$686.00
|
| Rate for Payer: Blue Shield of California EPN |
$431.10
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.14
|
| Rate for Payer: EPIC Health Plan Senior |
$342.14
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$504.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.02
|
| Rate for Payer: United Healthcare All Other HMO |
$312.46
|
| Rate for Payer: United Healthcare HMO Rider |
$305.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.13
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT. [40814135]
|
Facility
|
OP
|
$855.36
|
|
|
Service Code
|
HCPCS J9218
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Adventist Health Commercial |
$171.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$641.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.74
|
| Rate for Payer: Blue Shield of California Commercial |
$66.95
|
| Rate for Payer: Blue Shield of California EPN |
$60.86
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.14
|
| Rate for Payer: EPIC Health Plan Senior |
$342.14
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$504.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$598.75
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
| Rate for Payer: Riverside University Health System MISP |
$342.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.02
|
| Rate for Payer: United Healthcare All Other HMO |
$312.46
|
| Rate for Payer: United Healthcare HMO Rider |
$305.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.06
|
| Rate for Payer: Vantage Medical Group Senior |
$727.06
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT [21108]
|
Facility
|
OP
|
$10,817.35
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$9,735.61 |
| Rate for Payer: Adventist Health Commercial |
$2,163.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,324.95
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Cash Price |
$4,867.81
|
| Rate for Payer: Cash Price |
$4,867.81
|
| Rate for Payer: Central Health Plan Commercial |
$8,653.88
|
| Rate for Payer: Cigna of CA HMO |
$7,572.15
|
| Rate for Payer: Cigna of CA PPO |
$7,572.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$9,194.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,490.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,735.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,869.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,163.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$8,113.01
|
| Rate for Payer: Networks By Design Commercial |
$5,408.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.34
|
| Rate for Payer: Prime Health Services Commercial |
$9,194.75
|
| Rate for Payer: Prime Health Services Medicare |
$169.96
|
| Rate for Payer: Riverside University Health System MISP |
$176.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,490.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,490.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,059.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3,951.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3,866.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,542.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT [21108]
|
Facility
|
IP
|
$10,817.35
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,163.47 |
| Max. Negotiated Rate |
$9,735.61 |
| Rate for Payer: Adventist Health Commercial |
$2,163.47
|
| Rate for Payer: Blue Shield of California Commercial |
$8,675.51
|
| Rate for Payer: Blue Shield of California EPN |
$5,451.94
|
| Rate for Payer: Cash Price |
$4,867.81
|
| Rate for Payer: Central Health Plan Commercial |
$8,653.88
|
| Rate for Payer: Cigna of CA HMO |
$7,572.15
|
| Rate for Payer: Cigna of CA PPO |
$7,572.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,326.94
|
| Rate for Payer: EPIC Health Plan Senior |
$4,326.94
|
| Rate for Payer: Galaxy Health WC |
$9,194.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,490.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,735.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,869.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,382.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,163.47
|
| Rate for Payer: Multiplan Commercial |
$8,113.01
|
| Rate for Payer: Networks By Design Commercial |
$5,408.68
|
| Rate for Payer: Prime Health Services Commercial |
$9,194.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,059.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3,951.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3,866.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,542.68
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]
|
Facility
|
OP
|
$2,269.40
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$453.88 |
| Max. Negotiated Rate |
$10,350.93 |
| Rate for Payer: Adventist Health Commercial |
$453.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,841.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,350.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,264.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,058.41
|
| Rate for Payer: Cash Price |
$1,021.23
|
| Rate for Payer: Cash Price |
$1,021.23
|
| Rate for Payer: Central Health Plan Commercial |
$1,815.52
|
| Rate for Payer: Cigna of CA HMO |
$1,588.58
|
| Rate for Payer: Cigna of CA PPO |
$1,588.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,588.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.39
|
| Rate for Payer: Galaxy Health WC |
$1,928.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,361.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,042.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,019.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,841.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,359.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,577.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,467.29
|
| Rate for Payer: Multiplan Commercial |
$1,702.05
|
| Rate for Payer: Networks By Design Commercial |
$1,134.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Prime Health Services Commercial |
$1,928.99
|
| Rate for Payer: Prime Health Services Medicare |
$1,951.74
|
| Rate for Payer: Riverside University Health System MISP |
$2,025.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,361.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,361.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.71
|
| Rate for Payer: United Healthcare All Other HMO |
$829.01
|
| Rate for Payer: United Healthcare HMO Rider |
$811.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,841.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.39
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]
|
Facility
|
IP
|
$2,269.40
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$453.88 |
| Max. Negotiated Rate |
$2,042.46 |
| Rate for Payer: Adventist Health Commercial |
$453.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,820.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,143.78
|
| Rate for Payer: Cash Price |
$1,021.23
|
| Rate for Payer: Central Health Plan Commercial |
$1,815.52
|
| Rate for Payer: Cigna of CA HMO |
$1,588.58
|
| Rate for Payer: Cigna of CA PPO |
$1,588.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,588.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$907.76
|
| Rate for Payer: EPIC Health Plan Senior |
$907.76
|
| Rate for Payer: Galaxy Health WC |
$1,928.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,361.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,042.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,441.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,338.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.88
|
| Rate for Payer: Multiplan Commercial |
$1,702.05
|
| Rate for Payer: Networks By Design Commercial |
$1,134.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,928.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$851.71
|
| Rate for Payer: United Healthcare All Other HMO |
$829.01
|
| Rate for Payer: United Healthcare HMO Rider |
$811.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.23
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]
|
Facility
|
OP
|
$542.03
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$1,324.95 |
| Rate for Payer: Adventist Health Commercial |
$108.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,324.95
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Central Health Plan Commercial |
$433.62
|
| Rate for Payer: Cigna of CA HMO |
$379.42
|
| Rate for Payer: Cigna of CA PPO |
$379.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$460.73
|
| Rate for Payer: Global Benefits Group Commercial |
$325.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$406.52
|
| Rate for Payer: Networks By Design Commercial |
$271.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.34
|
| Rate for Payer: Prime Health Services Commercial |
$460.73
|
| Rate for Payer: Prime Health Services Medicare |
$169.96
|
| Rate for Payer: Riverside University Health System MISP |
$176.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.42
|
| Rate for Payer: United Healthcare All Other HMO |
$198.00
|
| Rate for Payer: United Healthcare HMO Rider |
$193.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]
|
Facility
|
IP
|
$542.03
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$487.83 |
| Rate for Payer: Adventist Health Commercial |
$108.41
|
| Rate for Payer: Blue Shield of California Commercial |
$434.71
|
| Rate for Payer: Blue Shield of California EPN |
$273.18
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Central Health Plan Commercial |
$433.62
|
| Rate for Payer: Cigna of CA HMO |
$379.42
|
| Rate for Payer: Cigna of CA PPO |
$379.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$379.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.81
|
| Rate for Payer: EPIC Health Plan Senior |
$216.81
|
| Rate for Payer: Galaxy Health WC |
$460.73
|
| Rate for Payer: Global Benefits Group Commercial |
$325.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$344.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.41
|
| Rate for Payer: Multiplan Commercial |
$406.52
|
| Rate for Payer: Networks By Design Commercial |
$271.01
|
| Rate for Payer: Prime Health Services Commercial |
$460.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.42
|
| Rate for Payer: United Healthcare All Other HMO |
$198.00
|
| Rate for Payer: United Healthcare HMO Rider |
$193.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.51
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [187503]
|
Facility
|
IP
|
$2,704.36
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$540.87 |
| Max. Negotiated Rate |
$2,433.92 |
| Rate for Payer: Adventist Health Commercial |
$540.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,363.00
|
| Rate for Payer: Cash Price |
$1,216.96
|
| Rate for Payer: Central Health Plan Commercial |
$2,163.49
|
| Rate for Payer: Cigna of CA HMO |
$1,893.05
|
| Rate for Payer: Cigna of CA PPO |
$1,893.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,893.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,081.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1,081.74
|
| Rate for Payer: Galaxy Health WC |
$2,298.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1,622.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,433.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,717.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,595.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.87
|
| Rate for Payer: Multiplan Commercial |
$2,028.27
|
| Rate for Payer: Networks By Design Commercial |
$1,352.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,298.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.95
|
| Rate for Payer: United Healthcare All Other HMO |
$987.90
|
| Rate for Payer: United Healthcare HMO Rider |
$966.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.68
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [187503]
|
Facility
|
OP
|
$2,704.36
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$2,433.92 |
| Rate for Payer: Adventist Health Commercial |
$540.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,324.95
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Cash Price |
$1,216.96
|
| Rate for Payer: Cash Price |
$1,216.96
|
| Rate for Payer: Central Health Plan Commercial |
$2,163.49
|
| Rate for Payer: Cigna of CA HMO |
$1,893.05
|
| Rate for Payer: Cigna of CA PPO |
$1,893.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,893.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$2,298.71
|
| Rate for Payer: Global Benefits Group Commercial |
$1,622.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,433.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,717.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$2,028.27
|
| Rate for Payer: Networks By Design Commercial |
$1,352.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.34
|
| Rate for Payer: Prime Health Services Commercial |
$2,298.71
|
| Rate for Payer: Prime Health Services Medicare |
$169.96
|
| Rate for Payer: Riverside University Health System MISP |
$176.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,622.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,622.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.95
|
| Rate for Payer: United Healthcare All Other HMO |
$987.90
|
| Rate for Payer: United Healthcare HMO Rider |
$966.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT [27123]
|
Facility
|
IP
|
$2,730.11
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$546.02 |
| Max. Negotiated Rate |
$2,457.10 |
| Rate for Payer: Adventist Health Commercial |
$546.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,189.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,375.98
|
| Rate for Payer: Cash Price |
$1,228.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.09
|
| Rate for Payer: Cigna of CA HMO |
$1,911.08
|
| Rate for Payer: Cigna of CA PPO |
$1,911.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.04
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.04
|
| Rate for Payer: Galaxy Health WC |
$2,320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,733.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,610.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.02
|
| Rate for Payer: Multiplan Commercial |
$2,047.58
|
| Rate for Payer: Networks By Design Commercial |
$1,365.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.61
|
| Rate for Payer: United Healthcare All Other HMO |
$997.31
|
| Rate for Payer: United Healthcare HMO Rider |
$975.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.11
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT [27123]
|
Facility
|
OP
|
$2,730.11
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$2,457.10 |
| Rate for Payer: Adventist Health Commercial |
$546.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,324.95
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Cash Price |
$1,228.55
|
| Rate for Payer: Cash Price |
$1,228.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.09
|
| Rate for Payer: Cigna of CA HMO |
$1,911.08
|
| Rate for Payer: Cigna of CA PPO |
$1,911.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.56
|
| Rate for Payer: EPIC Health Plan Senior |
$176.37
|
| Rate for Payer: Galaxy Health WC |
$2,320.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,733.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.86
|
| Rate for Payer: Multiplan Commercial |
$2,047.58
|
| Rate for Payer: Networks By Design Commercial |
$1,365.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.34
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.59
|
| Rate for Payer: Prime Health Services Medicare |
$169.96
|
| Rate for Payer: Riverside University Health System MISP |
$176.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,024.61
|
| Rate for Payer: United Healthcare All Other HMO |
$997.31
|
| Rate for Payer: United Healthcare HMO Rider |
$975.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.37
|
| Rate for Payer: Vantage Medical Group Senior |
$176.37
|
|
|
LEUPROLIDE ACETATE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21044]
|
Facility
|
IP
|
$6,808.25
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,361.65 |
| Max. Negotiated Rate |
$6,127.43 |
| Rate for Payer: Adventist Health Commercial |
$1,361.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,460.22
|
| Rate for Payer: Blue Shield of California EPN |
$3,431.36
|
| Rate for Payer: Cash Price |
$3,063.71
|
| Rate for Payer: Central Health Plan Commercial |
$5,446.60
|
| Rate for Payer: Cigna of CA HMO |
$4,765.77
|
| Rate for Payer: Cigna of CA PPO |
$4,765.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,765.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,723.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2,723.30
|
| Rate for Payer: Galaxy Health WC |
$5,787.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4,084.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,323.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,016.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.65
|
| Rate for Payer: Multiplan Commercial |
$5,106.19
|
| Rate for Payer: Networks By Design Commercial |
$3,404.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,787.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,555.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2,487.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,433.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,229.70
|
|
|
LEUPROLIDE ACETATE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21044]
|
Facility
|
OP
|
$6,808.25
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$889.07 |
| Max. Negotiated Rate |
$10,350.93 |
| Rate for Payer: Adventist Health Commercial |
$1,361.65
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,841.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,350.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,264.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,058.41
|
| Rate for Payer: Cash Price |
$3,063.71
|
| Rate for Payer: Cash Price |
$3,063.71
|
| Rate for Payer: Central Health Plan Commercial |
$5,446.60
|
| Rate for Payer: Cigna of CA HMO |
$4,765.77
|
| Rate for Payer: Cigna of CA PPO |
$4,765.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,025.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,025.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,765.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.39
|
| Rate for Payer: Galaxy Health WC |
$5,787.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4,084.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,127.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,019.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,841.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,323.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,359.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,577.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,467.29
|
| Rate for Payer: Multiplan Commercial |
$5,106.19
|
| Rate for Payer: Networks By Design Commercial |
$3,404.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,841.26
|
| Rate for Payer: Prime Health Services Commercial |
$5,787.01
|
| Rate for Payer: Prime Health Services Medicare |
$1,951.74
|
| Rate for Payer: Riverside University Health System MISP |
$2,025.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,084.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,084.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,555.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2,487.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,433.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,229.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,841.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,301.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,025.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.39
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21045]
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Facility
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IP
|
$8,112.98
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Service Code
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HCPCS J9217
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| Hospital Charge Code |
901700025
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Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,622.60 |
| Max. Negotiated Rate |
$7,301.68 |
| Rate for Payer: Adventist Health Commercial |
$1,622.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,506.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,088.94
|
| Rate for Payer: Cash Price |
$3,650.84
|
| Rate for Payer: Central Health Plan Commercial |
$6,490.38
|
| Rate for Payer: Cigna of CA HMO |
$5,679.09
|
| Rate for Payer: Cigna of CA PPO |
$5,679.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,679.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,245.19
|
| Rate for Payer: EPIC Health Plan Senior |
$3,245.19
|
| Rate for Payer: Galaxy Health WC |
$6,896.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4,867.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,301.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,151.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,786.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$6,084.73
|
| Rate for Payer: Networks By Design Commercial |
$4,056.49
|
| Rate for Payer: Prime Health Services Commercial |
$6,896.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,044.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,899.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,657.00
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