|
LEUPROLIDE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21044]
|
Facility
OP
|
$5,881.22
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
ERX21044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$889.07 |
| Max. Negotiated Rate |
$9,695.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,564.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,695.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,955.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,721.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,721.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$973.45
|
| Rate for Payer: BCBS Transplant Transplant |
$3,528.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,843.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.92
|
| Rate for Payer: Caremore Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$2,646.55
|
| Rate for Payer: Cash Price |
$2,646.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,704.98
|
| Rate for Payer: Cigna of CA HMO |
$4,116.85
|
| Rate for Payer: Cigna of CA PPO |
$4,116.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,346.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,564.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,564.60
|
| Rate for Payer: Galaxy Health WC |
$4,999.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3,528.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,293.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,410.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,565.95
|
| Rate for Payer: IEHP medi-cal |
$2,581.60
|
| Rate for Payer: IEHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Innovage PACE Commercial |
$2,346.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,922.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,564.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,176.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,096.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,096.57
|
| Rate for Payer: Multiplan Commercial |
$4,410.92
|
| Rate for Payer: Networks By Design Commercial |
$2,940.61
|
| Rate for Payer: Prime Health Services Commercial |
$4,999.04
|
| Rate for Payer: Prime Health Services Medicare |
$1,658.48
|
| Rate for Payer: Riverside University Health MISP |
$1,721.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,528.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,528.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,940.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,940.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,940.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,940.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,346.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.60
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT [10390]
|
Facility
OP
|
$4,281.55
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
1722009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$856.31 |
| Max. Negotiated Rate |
$9,695.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,564.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,695.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,955.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,721.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,721.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$973.45
|
| Rate for Payer: BCBS Transplant Transplant |
$2,568.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,843.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.92
|
| Rate for Payer: Caremore Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$1,926.70
|
| Rate for Payer: Cash Price |
$1,926.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,425.24
|
| Rate for Payer: Cigna of CA HMO |
$2,997.08
|
| Rate for Payer: Cigna of CA PPO |
$2,997.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,346.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,564.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,564.60
|
| Rate for Payer: Galaxy Health WC |
$3,639.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2,568.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,853.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,211.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,565.95
|
| Rate for Payer: IEHP medi-cal |
$2,581.60
|
| Rate for Payer: IEHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Innovage PACE Commercial |
$2,346.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,855.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,564.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$856.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,096.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,096.57
|
| Rate for Payer: Multiplan Commercial |
$3,211.16
|
| Rate for Payer: Networks By Design Commercial |
$2,140.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,639.32
|
| Rate for Payer: Prime Health Services Medicare |
$1,658.48
|
| Rate for Payer: Riverside University Health MISP |
$1,721.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,568.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,568.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,140.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,140.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,140.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,140.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,346.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.60
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT [10390]
|
Facility
IP
|
$4,281.55
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
1722009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$856.31 |
| Max. Negotiated Rate |
$3,853.40 |
| Rate for Payer: Blue Shield of California Commercial |
$3,211.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,286.35
|
| Rate for Payer: Cash Price |
$1,926.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,425.24
|
| Rate for Payer: Cigna of CA HMO |
$2,997.08
|
| Rate for Payer: Cigna of CA PPO |
$2,997.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,712.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,712.62
|
| Rate for Payer: Galaxy Health WC |
$3,639.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2,568.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,853.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,855.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$856.31
|
| Rate for Payer: Multiplan Commercial |
$3,211.16
|
| Rate for Payer: Networks By Design Commercial |
$2,140.78
|
| Rate for Payer: Prime Health Services Commercial |
$3,639.32
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT [14135]
|
Facility
OP
|
$855.36
|
|
|
Service Code
|
CPT J9218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.66
|
| Rate for Payer: BCBS Transplant Transplant |
$513.22
|
| Rate for Payer: Blue Shield of California Commercial |
$66.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.79
|
| Rate for Payer: Caremore Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$641.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.54
|
| Rate for Payer: IEHP medi-cal |
$22.68
|
| Rate for Payer: IEHP Medicare Advantage |
$13.74
|
| Rate for Payer: Innovage PACE Commercial |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.42
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
| Rate for Payer: Prime Health Services Medicare |
$14.57
|
| Rate for Payer: Riverside University Health MISP |
$15.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.68
|
| Rate for Payer: United Healthcare All Other HMO |
$427.68
|
| Rate for Payer: United Healthcare HMO Rider |
$427.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.12
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT [14135]
|
Facility
IP
|
$855.36
|
|
|
Service Code
|
CPT J9218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.07 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Blue Shield of California Commercial |
$641.52
|
| Rate for Payer: Blue Shield of California EPN |
$456.76
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$342.14
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT. [40814135]
|
Facility
OP
|
$855.36
|
|
|
Service Code
|
CPT J9218
|
| Hospital Charge Code |
1756590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.66
|
| Rate for Payer: BCBS Transplant Transplant |
$513.22
|
| Rate for Payer: Blue Shield of California Commercial |
$66.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.79
|
| Rate for Payer: Caremore Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$641.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.54
|
| Rate for Payer: IEHP medi-cal |
$22.68
|
| Rate for Payer: IEHP Medicare Advantage |
$13.74
|
| Rate for Payer: Innovage PACE Commercial |
$20.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.42
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
| Rate for Payer: Prime Health Services Medicare |
$14.57
|
| Rate for Payer: Riverside University Health MISP |
$15.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.68
|
| Rate for Payer: United Healthcare All Other HMO |
$427.68
|
| Rate for Payer: United Healthcare HMO Rider |
$427.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.12
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT. [40814135]
|
Facility
IP
|
$855.36
|
|
|
Service Code
|
CPT J9218
|
| Hospital Charge Code |
1756590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.07 |
| Max. Negotiated Rate |
$769.82 |
| Rate for Payer: Blue Shield of California Commercial |
$641.52
|
| Rate for Payer: Blue Shield of California EPN |
$456.76
|
| Rate for Payer: Cash Price |
$384.91
|
| Rate for Payer: Central Health Plan Commercial |
$684.29
|
| Rate for Payer: Cigna of CA HMO |
$598.75
|
| Rate for Payer: Cigna of CA PPO |
$598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$342.14
|
| Rate for Payer: Galaxy Health WC |
$727.06
|
| Rate for Payer: Global Benefits Group Commercial |
$513.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.07
|
| Rate for Payer: Multiplan Commercial |
$641.52
|
| Rate for Payer: Networks By Design Commercial |
$427.68
|
| Rate for Payer: Prime Health Services Commercial |
$727.06
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21045]
|
Facility
IP
|
$7,008.31
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1720692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,401.66 |
| Max. Negotiated Rate |
$6,307.48 |
| Rate for Payer: Blue Shield of California Commercial |
$5,256.23
|
| Rate for Payer: Blue Shield of California EPN |
$3,742.44
|
| Rate for Payer: Cash Price |
$3,153.74
|
| Rate for Payer: Central Health Plan Commercial |
$5,606.65
|
| Rate for Payer: Cigna of CA HMO |
$4,905.82
|
| Rate for Payer: Cigna of CA PPO |
$4,905.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,803.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,803.32
|
| Rate for Payer: Galaxy Health WC |
$5,957.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4,204.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,307.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,674.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.66
|
| Rate for Payer: Multiplan Commercial |
$5,256.23
|
| Rate for Payer: Networks By Design Commercial |
$3,504.16
|
| Rate for Payer: Prime Health Services Commercial |
$5,957.06
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT [21045]
|
Facility
OP
|
$7,008.31
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1720692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$6,307.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$4,204.99
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$3,153.74
|
| Rate for Payer: Cash Price |
$3,153.74
|
| Rate for Payer: Central Health Plan Commercial |
$5,606.65
|
| Rate for Payer: Cigna of CA HMO |
$4,905.82
|
| Rate for Payer: Cigna of CA PPO |
$4,905.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$5,957.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4,204.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,307.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,256.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,674.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$5,256.23
|
| Rate for Payer: Networks By Design Commercial |
$3,504.16
|
| Rate for Payer: Prime Health Services Commercial |
$5,957.06
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,204.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,204.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,504.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3,504.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3,504.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,504.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]
|
Facility
OP
|
$1,626.08
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1721163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$1,463.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$975.65
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$731.74
|
| Rate for Payer: Cash Price |
$731.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.86
|
| Rate for Payer: Cigna of CA HMO |
$1,138.26
|
| Rate for Payer: Cigna of CA PPO |
$1,138.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$1,382.17
|
| Rate for Payer: Global Benefits Group Commercial |
$975.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,219.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,084.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$1,219.56
|
| Rate for Payer: Networks By Design Commercial |
$813.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.17
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$813.04
|
| Rate for Payer: United Healthcare All Other HMO |
$813.04
|
| Rate for Payer: United Healthcare HMO Rider |
$813.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE [33669]
|
Facility
IP
|
$1,626.08
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1721163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.22 |
| Max. Negotiated Rate |
$1,463.47 |
| Rate for Payer: Blue Shield of California Commercial |
$1,219.56
|
| Rate for Payer: Blue Shield of California EPN |
$868.33
|
| Rate for Payer: Cash Price |
$731.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.86
|
| Rate for Payer: Cigna of CA HMO |
$1,138.26
|
| Rate for Payer: Cigna of CA PPO |
$1,138.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$650.43
|
| Rate for Payer: Galaxy Health WC |
$1,382.17
|
| Rate for Payer: Global Benefits Group Commercial |
$975.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,084.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.22
|
| Rate for Payer: Multiplan Commercial |
$1,219.56
|
| Rate for Payer: Networks By Design Commercial |
$813.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.17
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT [21108]
|
Facility
IP
|
$9,344.44
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1720911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,868.89 |
| Max. Negotiated Rate |
$8,410.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,008.33
|
| Rate for Payer: Blue Shield of California EPN |
$4,989.93
|
| Rate for Payer: Cash Price |
$4,205.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,475.55
|
| Rate for Payer: Cigna of CA HMO |
$6,541.11
|
| Rate for Payer: Cigna of CA PPO |
$6,541.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,737.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,737.78
|
| Rate for Payer: Galaxy Health WC |
$7,942.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5,606.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,410.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,232.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.89
|
| Rate for Payer: Multiplan Commercial |
$7,008.33
|
| Rate for Payer: Networks By Design Commercial |
$4,672.22
|
| Rate for Payer: Prime Health Services Commercial |
$7,942.77
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT [21108]
|
Facility
OP
|
$9,344.44
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1720911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$8,410.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$5,606.66
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$4,205.00
|
| Rate for Payer: Cash Price |
$4,205.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,475.55
|
| Rate for Payer: Cigna of CA HMO |
$6,541.11
|
| Rate for Payer: Cigna of CA PPO |
$6,541.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$7,942.77
|
| Rate for Payer: Global Benefits Group Commercial |
$5,606.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,410.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,008.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,232.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$7,008.33
|
| Rate for Payer: Networks By Design Commercial |
$4,672.22
|
| Rate for Payer: Prime Health Services Commercial |
$7,942.77
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,606.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,606.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,672.22
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.22
|
| Rate for Payer: United Healthcare HMO Rider |
$4,672.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,672.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]
|
Facility
IP
|
$1,960.39
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
1721031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$392.08 |
| Max. Negotiated Rate |
$1,764.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1,470.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,046.85
|
| Rate for Payer: Cash Price |
$882.18
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.31
|
| Rate for Payer: Cigna of CA HMO |
$1,372.27
|
| Rate for Payer: Cigna of CA PPO |
$1,372.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.16
|
| Rate for Payer: Galaxy Health WC |
$1,666.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.08
|
| Rate for Payer: Multiplan Commercial |
$1,470.29
|
| Rate for Payer: Networks By Design Commercial |
$980.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.33
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT [13691]
|
Facility
OP
|
$1,960.39
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
1721031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$392.08 |
| Max. Negotiated Rate |
$9,695.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,564.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,695.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,955.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,721.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,721.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$889.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$973.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1,176.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,843.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,675.92
|
| Rate for Payer: Caremore Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$882.18
|
| Rate for Payer: Cash Price |
$882.18
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.31
|
| Rate for Payer: Cigna of CA HMO |
$1,372.27
|
| Rate for Payer: Cigna of CA PPO |
$1,372.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,346.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,564.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,564.60
|
| Rate for Payer: Galaxy Health WC |
$1,666.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,470.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,565.95
|
| Rate for Payer: IEHP medi-cal |
$2,581.60
|
| Rate for Payer: IEHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Innovage PACE Commercial |
$2,346.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,564.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,096.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,096.57
|
| Rate for Payer: Multiplan Commercial |
$1,470.29
|
| Rate for Payer: Networks By Design Commercial |
$980.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.33
|
| Rate for Payer: Prime Health Services Medicare |
$1,658.48
|
| Rate for Payer: Riverside University Health MISP |
$1,721.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$980.20
|
| Rate for Payer: United Healthcare All Other HMO |
$980.20
|
| Rate for Payer: United Healthcare HMO Rider |
$980.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$980.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,346.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.60
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]
|
Facility
OP
|
$542.03
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1721162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$1,162.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$325.22
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Central Health Plan Commercial |
$433.62
|
| Rate for Payer: Cigna of CA HMO |
$379.42
|
| Rate for Payer: Cigna of CA PPO |
$379.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$460.73
|
| Rate for Payer: Global Benefits Group Commercial |
$325.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$406.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$406.52
|
| Rate for Payer: Networks By Design Commercial |
$271.02
|
| Rate for Payer: Prime Health Services Commercial |
$460.73
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.02
|
| Rate for Payer: United Healthcare All Other HMO |
$271.02
|
| Rate for Payer: United Healthcare HMO Rider |
$271.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE [32893]
|
Facility
IP
|
$542.03
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1721162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$487.83 |
| Rate for Payer: Blue Shield of California Commercial |
$406.52
|
| Rate for Payer: Blue Shield of California EPN |
$289.44
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Central Health Plan Commercial |
$433.62
|
| Rate for Payer: Cigna of CA HMO |
$379.42
|
| Rate for Payer: Cigna of CA PPO |
$379.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.81
|
| Rate for Payer: Galaxy Health WC |
$460.73
|
| Rate for Payer: Global Benefits Group Commercial |
$325.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$487.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.41
|
| Rate for Payer: Multiplan Commercial |
$406.52
|
| Rate for Payer: Networks By Design Commercial |
$271.02
|
| Rate for Payer: Prime Health Services Commercial |
$460.73
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [187503]
|
Facility
OP
|
$2,336.11
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
ERX187503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$2,102.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1,401.67
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,868.89
|
| Rate for Payer: Cigna of CA HMO |
$1,635.28
|
| Rate for Payer: Cigna of CA PPO |
$1,635.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$1,985.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1,401.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,102.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,752.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,558.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$1,752.08
|
| Rate for Payer: Networks By Design Commercial |
$1,168.06
|
| Rate for Payer: Prime Health Services Commercial |
$1,985.69
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,401.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,401.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,168.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1,168.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,168.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,168.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT [187503]
|
Facility
IP
|
$2,336.11
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
ERX187503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.22 |
| Max. Negotiated Rate |
$2,102.50 |
| Rate for Payer: Blue Shield of California Commercial |
$1,752.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,247.48
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,868.89
|
| Rate for Payer: Cigna of CA HMO |
$1,635.28
|
| Rate for Payer: Cigna of CA PPO |
$1,635.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$934.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$934.44
|
| Rate for Payer: Galaxy Health WC |
$1,985.69
|
| Rate for Payer: Global Benefits Group Commercial |
$1,401.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,558.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.22
|
| Rate for Payer: Multiplan Commercial |
$1,752.08
|
| Rate for Payer: Networks By Design Commercial |
$1,168.06
|
| Rate for Payer: Prime Health Services Commercial |
$1,985.69
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT [27123]
|
Facility
OP
|
$2,358.36
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1720544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$2,122.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1,415.02
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$1,061.26
|
| Rate for Payer: Cash Price |
$1,061.26
|
| Rate for Payer: Central Health Plan Commercial |
$1,886.69
|
| Rate for Payer: Cigna of CA HMO |
$1,650.85
|
| Rate for Payer: Cigna of CA PPO |
$1,650.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$2,004.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,415.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,122.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,768.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,573.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$1,768.77
|
| Rate for Payer: Networks By Design Commercial |
$1,179.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,004.61
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,415.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,415.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1,179.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,179.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,179.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT [27123]
|
Facility
IP
|
$2,358.36
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
1720544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.67 |
| Max. Negotiated Rate |
$2,122.52 |
| Rate for Payer: Blue Shield of California Commercial |
$1,768.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,259.36
|
| Rate for Payer: Cash Price |
$1,061.26
|
| Rate for Payer: Central Health Plan Commercial |
$1,886.69
|
| Rate for Payer: Cigna of CA HMO |
$1,650.85
|
| Rate for Payer: Cigna of CA PPO |
$1,650.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$943.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$943.34
|
| Rate for Payer: Galaxy Health WC |
$2,004.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1,415.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,122.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,573.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.67
|
| Rate for Payer: Multiplan Commercial |
$1,768.77
|
| Rate for Payer: Networks By Design Commercial |
$1,179.18
|
| Rate for Payer: Prime Health Services Commercial |
$2,004.61
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT [153492]
|
Facility
IP
|
$14,016.85
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
ERX153492
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,803.37 |
| Max. Negotiated Rate |
$12,615.16 |
| Rate for Payer: Blue Shield of California Commercial |
$10,512.64
|
| Rate for Payer: Blue Shield of California EPN |
$7,485.00
|
| Rate for Payer: Cash Price |
$6,307.58
|
| Rate for Payer: Central Health Plan Commercial |
$11,213.48
|
| Rate for Payer: Cigna of CA HMO |
$9,811.80
|
| Rate for Payer: Cigna of CA PPO |
$9,811.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,606.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,606.74
|
| Rate for Payer: Galaxy Health WC |
$11,914.32
|
| Rate for Payer: Global Benefits Group Commercial |
$8,410.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,615.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,349.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,803.37
|
| Rate for Payer: Multiplan Commercial |
$10,512.64
|
| Rate for Payer: Networks By Design Commercial |
$7,008.42
|
| Rate for Payer: Prime Health Services Commercial |
$11,914.32
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT [153492]
|
Facility
OP
|
$14,016.85
|
|
|
Service Code
|
CPT J9217
|
| Hospital Charge Code |
ERX153492
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$12,615.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$181.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,162.49
|
| Rate for Payer: BCBS Transplant Transplant |
$8,410.11
|
| Rate for Payer: Blue Shield of California Commercial |
$596.23
|
| Rate for Payer: Blue Shield of California EPN |
$542.03
|
| Rate for Payer: Caremore Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$6,307.58
|
| Rate for Payer: Cash Price |
$6,307.58
|
| Rate for Payer: Central Health Plan Commercial |
$11,213.48
|
| Rate for Payer: Cigna of CA HMO |
$9,811.80
|
| Rate for Payer: Cigna of CA PPO |
$9,811.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$181.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$181.30
|
| Rate for Payer: Galaxy Health WC |
$11,914.32
|
| Rate for Payer: Global Benefits Group Commercial |
$8,410.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,615.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,512.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$297.34
|
| Rate for Payer: IEHP medi-cal |
$299.15
|
| Rate for Payer: IEHP Medicare Advantage |
$181.30
|
| Rate for Payer: Innovage PACE Commercial |
$271.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,349.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,803.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.94
|
| Rate for Payer: Multiplan Commercial |
$10,512.64
|
| Rate for Payer: Networks By Design Commercial |
$7,008.42
|
| Rate for Payer: Prime Health Services Commercial |
$11,914.32
|
| Rate for Payer: Prime Health Services Medicare |
$192.18
|
| Rate for Payer: Riverside University Health MISP |
$199.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,410.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,410.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,008.42
|
| Rate for Payer: United Healthcare All Other HMO |
$7,008.42
|
| Rate for Payer: United Healthcare HMO Rider |
$7,008.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,008.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.43
|
| Rate for Payer: Vantage Medical Group Senior |
$181.30
|
|
|
LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]
|
Facility
OP
|
$0.64
|
|
|
Service Code
|
NDC 0093-4148-45
|
| Hospital Charge Code |
1781108
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: BCBS Transplant Transplant |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.48
|
| Rate for Payer: IEHP medi-cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Vantage Medical Group Senior |
$0.54
|
|
|
LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [24916]
|
Facility
IP
|
$0.64
|
|
|
Service Code
|
NDC 0093-4148-45
|
| Hospital Charge Code |
1781108
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.45
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.48
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$0.54
|
|
