|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
IP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
1743682
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
IP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-00
|
| Hospital Charge Code |
1743682
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
OP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
1743682
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.48
|
| Rate for Payer: BCBS Transplant Transplant |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Central Health Plan Commercial |
$2.00
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.88
|
| Rate for Payer: IEHP medi-cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: Riverside University Health MISP |
$1.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
IMMUNE GLOB G 1 GRAM/5 ML(20 %)-PROL-IGA 0-50 MCG/ML SUBCUTANEOUS SOLN [108090]
|
Facility
OP
|
$51.49
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
NDG108090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$80.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.25
|
| Rate for Payer: BCBS Transplant Transplant |
$30.89
|
| Rate for Payer: Blue Shield of California Commercial |
$24.02
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Caremore Medicare Advantage |
$12.94
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Central Health Plan Commercial |
$41.19
|
| Rate for Payer: Cigna of CA HMO |
$36.04
|
| Rate for Payer: Cigna of CA PPO |
$36.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.94
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.23
|
| Rate for Payer: IEHP medi-cal |
$21.36
|
| Rate for Payer: IEHP Medicare Advantage |
$12.94
|
| Rate for Payer: Innovage PACE Commercial |
$19.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$25.74
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
| Rate for Payer: Prime Health Services Medicare |
$13.72
|
| Rate for Payer: Riverside University Health MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.74
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.94
|
|
|
IMMUNE GLOB G 1 GRAM/5 ML(20 %)-PROL-IGA 0-50 MCG/ML SUBCUTANEOUS SOLN [108090]
|
Facility
IP
|
$51.49
|
|
|
Service Code
|
CPT J1559
|
| Hospital Charge Code |
NDG108090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$46.34 |
| Rate for Payer: Blue Shield of California Commercial |
$38.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.50
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Central Health Plan Commercial |
$41.19
|
| Rate for Payer: Cigna of CA HMO |
$36.04
|
| Rate for Payer: Cigna of CA PPO |
$36.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.30
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$25.74
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]
|
Facility
OP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$308.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$49.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$9.86
|
| Rate for Payer: Blue Shield of California Commercial |
$80.64
|
| Rate for Payer: Blue Shield of California EPN |
$73.31
|
| Rate for Payer: Caremore Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Central Health Plan Commercial |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.79
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.65
|
| Rate for Payer: IEHP medi-cal |
$82.15
|
| Rate for Payer: IEHP Medicare Advantage |
$49.79
|
| Rate for Payer: Innovage PACE Commercial |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.71
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Prime Health Services Medicare |
$52.77
|
| Rate for Payer: Riverside University Health MISP |
$54.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: Vantage Medical Group Senior |
$49.79
|
|
|
IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [107754]
|
Facility
IP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG107754
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Blue Shield of California Commercial |
$12.32
|
| Rate for Payer: Blue Shield of California EPN |
$8.77
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Central Health Plan Commercial |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.57
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [207906]
|
Facility
IP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG207906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Blue Shield of California Commercial |
$12.32
|
| Rate for Payer: Blue Shield of California EPN |
$8.77
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Central Health Plan Commercial |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.57
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN [207906]
|
Facility
OP
|
$16.43
|
|
|
Service Code
|
CPT J1561
|
| Hospital Charge Code |
NDG207906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$308.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$49.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$9.86
|
| Rate for Payer: Blue Shield of California Commercial |
$80.64
|
| Rate for Payer: Blue Shield of California EPN |
$73.31
|
| Rate for Payer: Caremore Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Cash Price |
$7.39
|
| Rate for Payer: Central Health Plan Commercial |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$11.50
|
| Rate for Payer: Cigna of CA PPO |
$11.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.79
|
| Rate for Payer: Galaxy Health WC |
$13.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.65
|
| Rate for Payer: IEHP medi-cal |
$82.15
|
| Rate for Payer: IEHP Medicare Advantage |
$49.79
|
| Rate for Payer: Innovage PACE Commercial |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.71
|
| Rate for Payer: Multiplan Commercial |
$12.32
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$13.97
|
| Rate for Payer: Prime Health Services Medicare |
$52.77
|
| Rate for Payer: Riverside University Health MISP |
$54.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.22
|
| Rate for Payer: United Healthcare All Other HMO |
$8.22
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.76
|
| Rate for Payer: Vantage Medical Group Senior |
$49.79
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.17
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Caremore Medicare Advantage |
$44.15
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.41
|
| Rate for Payer: IEHP medi-cal |
$72.85
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Innovage PACE Commercial |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Prime Health Services Medicare |
$46.80
|
| Rate for Payer: Riverside University Health MISP |
$48.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.17
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Caremore Medicare Advantage |
$44.15
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.41
|
| Rate for Payer: IEHP medi-cal |
$72.85
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Innovage PACE Commercial |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Prime Health Services Medicare |
$46.80
|
| Rate for Payer: Riverside University Health MISP |
$48.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.17
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Caremore Medicare Advantage |
$44.15
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.41
|
| Rate for Payer: IEHP medi-cal |
$72.85
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Innovage PACE Commercial |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Prime Health Services Medicare |
$46.80
|
| Rate for Payer: Riverside University Health MISP |
$48.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
1759128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Blue Shield of California Commercial |
$14.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
1759128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.17
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Caremore Medicare Advantage |
$44.15
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.41
|
| Rate for Payer: IEHP medi-cal |
$72.85
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Innovage PACE Commercial |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Prime Health Services Medicare |
$46.80
|
| Rate for Payer: Riverside University Health MISP |
$48.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION [209934]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
CPT J1569
|
| Hospital Charge Code |
NDG209934B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$273.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.17
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$85.67
|
| Rate for Payer: Caremore Medicare Advantage |
$44.15
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.15
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$72.41
|
| Rate for Payer: IEHP medi-cal |
$72.85
|
| Rate for Payer: IEHP Medicare Advantage |
$44.15
|
| Rate for Payer: Innovage PACE Commercial |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Prime Health Services Medicare |
$46.80
|
| Rate for Payer: Riverside University Health MISP |
$48.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.15
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [210304]
|
Facility
IP
|
$2,587.56
|
|
|
Service Code
|
CPT J1566
|
| Hospital Charge Code |
NDG10258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.51 |
| Max. Negotiated Rate |
$2,328.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1,940.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,381.76
|
| Rate for Payer: Cash Price |
$1,164.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,070.05
|
| Rate for Payer: Cigna of CA HMO |
$1,811.29
|
| Rate for Payer: Cigna of CA PPO |
$1,811.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,035.02
|
| Rate for Payer: Galaxy Health WC |
$2,199.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,328.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,725.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.51
|
| Rate for Payer: Multiplan Commercial |
$1,940.67
|
| Rate for Payer: Networks By Design Commercial |
$1,293.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.43
|
|
|
IMMUNE GLOB,GAMMA(IGG) 10 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION [210304]
|
Facility
OP
|
$2,587.56
|
|
|
Service Code
|
CPT J1566
|
| Hospital Charge Code |
NDG10258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$2,328.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$78.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$86.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.34
|
| Rate for Payer: BCBS Transplant Transplant |
$1,552.54
|
| Rate for Payer: Blue Shield of California Commercial |
$124.03
|
| Rate for Payer: Blue Shield of California EPN |
$112.75
|
| Rate for Payer: Caremore Medicare Advantage |
$78.50
|
| Rate for Payer: Cash Price |
$1,164.40
|
| Rate for Payer: Cash Price |
$1,164.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,070.05
|
| Rate for Payer: Cigna of CA HMO |
$1,811.29
|
| Rate for Payer: Cigna of CA PPO |
$1,811.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$78.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$78.50
|
| Rate for Payer: Galaxy Health WC |
$2,199.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,328.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,940.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$128.74
|
| Rate for Payer: IEHP medi-cal |
$129.52
|
| Rate for Payer: IEHP Medicare Advantage |
$78.50
|
| Rate for Payer: Innovage PACE Commercial |
$117.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,725.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.19
|
| Rate for Payer: Multiplan Commercial |
$1,940.67
|
| Rate for Payer: Networks By Design Commercial |
$1,293.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,199.43
|
| Rate for Payer: Prime Health Services Medicare |
$83.21
|
| Rate for Payer: Riverside University Health MISP |
$86.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,552.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,552.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,293.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,293.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,293.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,293.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Vantage Medical Group Senior |
$78.50
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
OP
|
$22.41
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG207352D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$278.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$278.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.75
|
| Rate for Payer: BCBS Transplant Transplant |
$13.45
|
| Rate for Payer: Blue Shield of California Commercial |
$112.37
|
| Rate for Payer: Blue Shield of California EPN |
$102.15
|
| Rate for Payer: Caremore Medicare Advantage |
$44.98
|
| Rate for Payer: Cash Price |
$10.08
|
| Rate for Payer: Cash Price |
$10.08
|
| Rate for Payer: Central Health Plan Commercial |
$17.93
|
| Rate for Payer: Cigna of CA HMO |
$15.69
|
| Rate for Payer: Cigna of CA PPO |
$15.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.98
|
| Rate for Payer: Galaxy Health WC |
$19.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$73.76
|
| Rate for Payer: IEHP medi-cal |
$74.21
|
| Rate for Payer: IEHP Medicare Advantage |
$44.98
|
| Rate for Payer: Innovage PACE Commercial |
$67.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$16.81
|
| Rate for Payer: Networks By Design Commercial |
$11.20
|
| Rate for Payer: Prime Health Services Commercial |
$19.05
|
| Rate for Payer: Prime Health Services Medicare |
$47.68
|
| Rate for Payer: Riverside University Health MISP |
$49.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.20
|
| Rate for Payer: United Healthcare All Other HMO |
$11.20
|
| Rate for Payer: United Healthcare HMO Rider |
$11.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.48
|
| Rate for Payer: Vantage Medical Group Senior |
$44.98
|
|
|
IMMUNE GLOB,GAMM(IGG)10 %-MALT-IGA OVER 50 MCG/ML INTRAVENOUS SOLUTION [207352]
|
Facility
IP
|
$22.41
|
|
|
Service Code
|
CPT J1568
|
| Hospital Charge Code |
NDG207352D
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Blue Shield of California Commercial |
$16.81
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$10.08
|
| Rate for Payer: Central Health Plan Commercial |
$17.93
|
| Rate for Payer: Cigna of CA HMO |
$15.69
|
| Rate for Payer: Cigna of CA PPO |
$15.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.96
|
| Rate for Payer: Galaxy Health WC |
$19.05
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$16.81
|
| Rate for Payer: Networks By Design Commercial |
$11.20
|
| Rate for Payer: Prime Health Services Commercial |
$19.05
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG209935A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$299.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$48.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$95.70
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Caremore Medicare Advantage |
$48.29
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.40
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.20
|
| Rate for Payer: IEHP medi-cal |
$79.68
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Innovage PACE Commercial |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Medicare |
$51.19
|
| Rate for Payer: Riverside University Health MISP |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
|
IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION [209935]
|
Facility
OP
|
$20.50
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
NDG108088C
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$299.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$48.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.61
|
| Rate for Payer: BCBS Transplant Transplant |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$95.70
|
| Rate for Payer: Blue Shield of California EPN |
$87.00
|
| Rate for Payer: Caremore Medicare Advantage |
$48.29
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Cash Price |
$9.23
|
| Rate for Payer: Central Health Plan Commercial |
$16.40
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$14.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.29
|
| Rate for Payer: Galaxy Health WC |
$17.42
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.20
|
| Rate for Payer: IEHP medi-cal |
$79.68
|
| Rate for Payer: IEHP Medicare Advantage |
$48.29
|
| Rate for Payer: Innovage PACE Commercial |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.71
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.42
|
| Rate for Payer: Prime Health Services Medicare |
$51.19
|
| Rate for Payer: Riverside University Health MISP |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.12
|
| Rate for Payer: Vantage Medical Group Senior |
$48.29
|
|
