|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 59651-362-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 64380-807-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0904-5855-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0904-5855-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: InnovAge PACE Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 64380-807-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 59651-362-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: InnovAge PACE Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0904-5855-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 67877-321-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: InnovAge PACE Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Riverside University Health System MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
OP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$246.37 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.39
|
| Rate for Payer: Cash Price |
$150.56
|
| Rate for Payer: Cash Price |
$150.56
|
| Rate for Payer: Central Health Plan Commercial |
$218.99
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.50
|
| Rate for Payer: EPIC Health Plan Senior |
$109.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.98
|
| Rate for Payer: InnovAge PACE Commercial |
$136.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.62
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: Riverside University Health System MISP |
$109.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.73
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.68
|
| Rate for Payer: Vantage Medical Group Senior |
$232.68
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
IP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$246.37 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Blue Shield of California Commercial |
$211.60
|
| Rate for Payer: Blue Shield of California EPN |
$137.96
|
| Rate for Payer: Cash Price |
$150.56
|
| Rate for Payer: Central Health Plan Commercial |
$218.99
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.50
|
| Rate for Payer: EPIC Health Plan Senior |
$109.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.73
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.65
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
OP
|
$67.18
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$669.63 |
| Rate for Payer: Adventist Health Commercial |
$13.44
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$669.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.51
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$365.42
|
| Rate for Payer: Cash Price |
$36.95
|
| Rate for Payer: Cash Price |
$36.95
|
| Rate for Payer: Central Health Plan Commercial |
$53.74
|
| Rate for Payer: Cigna of CA HMO |
$47.03
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$273.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.73
|
| Rate for Payer: EPIC Health Plan Senior |
$219.06
|
| Rate for Payer: Galaxy Health WC |
$57.10
|
| Rate for Payer: Global Benefits Group Commercial |
$40.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.06
|
| Rate for Payer: InnovAge PACE Commercial |
$328.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.54
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: Networks By Design Commercial |
$33.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.06
|
| Rate for Payer: Prime Health Services Commercial |
$57.10
|
| Rate for Payer: Prime Health Services Medicare |
$232.20
|
| Rate for Payer: Riverside University Health System MISP |
$240.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.21
|
| Rate for Payer: United Healthcare All Other HMO |
$24.54
|
| Rate for Payer: United Healthcare HMO Rider |
$24.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$273.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.96
|
| Rate for Payer: Vantage Medical Group Senior |
$240.96
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$60.46 |
| Rate for Payer: Adventist Health Commercial |
$13.44
|
| Rate for Payer: Blue Shield of California Commercial |
$51.93
|
| Rate for Payer: Blue Shield of California EPN |
$33.86
|
| Rate for Payer: Cash Price |
$36.95
|
| Rate for Payer: Central Health Plan Commercial |
$53.74
|
| Rate for Payer: Cigna of CA HMO |
$47.03
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.87
|
| Rate for Payer: EPIC Health Plan Senior |
$26.87
|
| Rate for Payer: Galaxy Health WC |
$57.10
|
| Rate for Payer: Global Benefits Group Commercial |
$40.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: Networks By Design Commercial |
$33.59
|
| Rate for Payer: Prime Health Services Commercial |
$57.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.21
|
| Rate for Payer: United Healthcare All Other HMO |
$24.54
|
| Rate for Payer: United Healthcare HMO Rider |
$24.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California Commercial |
$12.42
|
| Rate for Payer: Blue Shield of California Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.60
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Blue Shield of California EPN |
$6.52
|
| Rate for Payer: Cash Price |
$8.84
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Central Health Plan Commercial |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.42
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.91
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Blue Shield of California Commercial |
$68.29
|
| Rate for Payer: Blue Shield of California EPN |
$62.08
|
| Rate for Payer: Blue Shield of California EPN |
$62.08
|
| Rate for Payer: Blue Shield of California EPN |
$62.08
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$8.84
|
| Rate for Payer: Cash Price |
$8.84
|
| Rate for Payer: Central Health Plan Commercial |
$9.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.51
|
| Rate for Payer: InnovAge PACE Commercial |
$6.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Riverside University Health System MISP |
$6.43
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Riverside University Health System MISP |
$4.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
OP
|
$61.23
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$55.11 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.96
|
| Rate for Payer: Blue Shield of California Commercial |
$37.41
|
| Rate for Payer: Blue Shield of California EPN |
$24.43
|
| Rate for Payer: Cash Price |
$33.68
|
| Rate for Payer: Central Health Plan Commercial |
$48.98
|
| Rate for Payer: Cigna of CA HMO |
$42.86
|
| Rate for Payer: Cigna of CA PPO |
$42.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$24.49
|
| Rate for Payer: Galaxy Health WC |
$52.05
|
| Rate for Payer: Global Benefits Group Commercial |
$36.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.11
|
| Rate for Payer: InnovAge PACE Commercial |
$30.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.86
|
| Rate for Payer: Multiplan Commercial |
$45.92
|
| Rate for Payer: Networks By Design Commercial |
$30.61
|
| Rate for Payer: Prime Health Services Commercial |
$52.05
|
| Rate for Payer: Riverside University Health System MISP |
$24.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.98
|
| Rate for Payer: United Healthcare All Other HMO |
$22.37
|
| Rate for Payer: United Healthcare HMO Rider |
$21.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.05
|
| Rate for Payer: Vantage Medical Group Senior |
$52.05
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
IP
|
$61.23
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$55.11 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Blue Shield of California Commercial |
$47.33
|
| Rate for Payer: Blue Shield of California EPN |
$30.86
|
| Rate for Payer: Cash Price |
$33.68
|
| Rate for Payer: Central Health Plan Commercial |
$48.98
|
| Rate for Payer: Cigna of CA HMO |
$42.86
|
| Rate for Payer: Cigna of CA PPO |
$42.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$24.49
|
| Rate for Payer: Galaxy Health WC |
$52.05
|
| Rate for Payer: Global Benefits Group Commercial |
$36.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$45.92
|
| Rate for Payer: Networks By Design Commercial |
$30.61
|
| Rate for Payer: Prime Health Services Commercial |
$52.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.98
|
| Rate for Payer: United Healthcare All Other HMO |
$22.37
|
| Rate for Payer: United Healthcare HMO Rider |
$21.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.05
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$80.79 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Central Health Plan Commercial |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.62
|
| Rate for Payer: InnovAge PACE Commercial |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: Riverside University Health System MISP |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Central Health Plan Commercial |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$1.54
|
| Rate for Payer: Cigna of CA PPO |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
IP
|
$69.66
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$62.69 |
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$53.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.08
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Central Health Plan Commercial |
$55.73
|
| Rate for Payer: Central Health Plan Commercial |
$35.27
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Networks By Design Commercial |
$22.05
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.14
|
| Rate for Payer: United Healthcare All Other HMO |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$24.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.81
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$80.79 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Central Health Plan Commercial |
$35.27
|
| Rate for Payer: Central Health Plan Commercial |
$55.73
|
| Rate for Payer: Cigna of CA HMO |
$48.76
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$48.76
|
| Rate for Payer: Cigna of CA PPO |
$30.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$17.64
|
| Rate for Payer: EPIC Health Plan Senior |
$27.86
|
| Rate for Payer: Galaxy Health WC |
$59.21
|
| Rate for Payer: Galaxy Health WC |
$37.48
|
| Rate for Payer: Global Benefits Group Commercial |
$41.80
|
| Rate for Payer: Global Benefits Group Commercial |
$26.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.62
|
| Rate for Payer: InnovAge PACE Commercial |
$22.05
|
| Rate for Payer: InnovAge PACE Commercial |
$34.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Networks By Design Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$22.05
|
| Rate for Payer: Prime Health Services Commercial |
$59.21
|
| Rate for Payer: Prime Health Services Commercial |
$37.48
|
| Rate for Payer: Riverside University Health System MISP |
$17.64
|
| Rate for Payer: Riverside University Health System MISP |
$27.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.55
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare All Other HMO |
$25.45
|
| Rate for Payer: United Healthcare HMO Rider |
$15.76
|
| Rate for Payer: United Healthcare HMO Rider |
$24.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$116.14 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.50
|
| Rate for Payer: Blue Shield of California EPN |
$44.09
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Central Health Plan Commercial |
$103.24
|
| Rate for Payer: Cigna of CA HMO |
$90.33
|
| Rate for Payer: Cigna of CA PPO |
$90.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Senior |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.62
|
| Rate for Payer: InnovAge PACE Commercial |
$64.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.33
|
| Rate for Payer: Multiplan Commercial |
$96.79
|
| Rate for Payer: Networks By Design Commercial |
$64.53
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: Riverside University Health System MISP |
$51.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.14
|
| Rate for Payer: United Healthcare HMO Rider |
$46.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.69
|
| Rate for Payer: Vantage Medical Group Senior |
$109.69
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$116.14 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Blue Shield of California Commercial |
$99.76
|
| Rate for Payer: Blue Shield of California EPN |
$65.04
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Central Health Plan Commercial |
$103.24
|
| Rate for Payer: Cigna of CA HMO |
$90.33
|
| Rate for Payer: Cigna of CA PPO |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Senior |
$51.62
|
| Rate for Payer: Galaxy Health WC |
$109.69
|
| Rate for Payer: Global Benefits Group Commercial |
$77.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.81
|
| Rate for Payer: Multiplan Commercial |
$96.79
|
| Rate for Payer: Networks By Design Commercial |
$64.53
|
| Rate for Payer: Prime Health Services Commercial |
$109.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.43
|
| Rate for Payer: United Healthcare All Other HMO |
$47.14
|
| Rate for Payer: United Healthcare HMO Rider |
$46.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.26
|
|
