|
PEGCETACOPLAN (PF) 15 MG/0.1 ML INTRAVITREAL SOLUTION [237231]
|
Facility
|
OP
|
$29,564.52
|
|
|
Service Code
|
HCPCS J2781
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.94 |
| Max. Negotiated Rate |
$26,608.07 |
| Rate for Payer: Adventist Health Commercial |
$5,912.90
|
| Rate for Payer: Adventist Health Commercial |
$5,631.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$148.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$148.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.65
|
| Rate for Payer: Blue Shield of California Commercial |
$192.72
|
| Rate for Payer: Blue Shield of California Commercial |
$192.72
|
| Rate for Payer: Blue Shield of California EPN |
$175.20
|
| Rate for Payer: Blue Shield of California EPN |
$175.20
|
| Rate for Payer: Cash Price |
$13,304.03
|
| Rate for Payer: Cash Price |
$12,670.51
|
| Rate for Payer: Cash Price |
$12,670.51
|
| Rate for Payer: Cash Price |
$13,304.03
|
| Rate for Payer: Central Health Plan Commercial |
$23,651.62
|
| Rate for Payer: Central Health Plan Commercial |
$22,525.34
|
| Rate for Payer: Cigna of CA HMO |
$20,695.16
|
| Rate for Payer: Cigna of CA HMO |
$19,709.68
|
| Rate for Payer: Cigna of CA PPO |
$20,695.16
|
| Rate for Payer: Cigna of CA PPO |
$19,709.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,709.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,695.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.75
|
| Rate for Payer: EPIC Health Plan Senior |
$163.83
|
| Rate for Payer: EPIC Health Plan Senior |
$163.83
|
| Rate for Payer: Galaxy Health WC |
$23,933.18
|
| Rate for Payer: Galaxy Health WC |
$25,129.84
|
| Rate for Payer: Global Benefits Group Commercial |
$17,738.71
|
| Rate for Payer: Global Benefits Group Commercial |
$16,894.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,341.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,608.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$244.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$244.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$148.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$148.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,879.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,773.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,631.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,912.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$199.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$199.58
|
| Rate for Payer: Multiplan Commercial |
$21,117.51
|
| Rate for Payer: Multiplan Commercial |
$22,173.39
|
| Rate for Payer: Networks By Design Commercial |
$14,078.34
|
| Rate for Payer: Networks By Design Commercial |
$14,782.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$148.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$148.94
|
| Rate for Payer: Prime Health Services Commercial |
$23,933.18
|
| Rate for Payer: Prime Health Services Commercial |
$25,129.84
|
| Rate for Payer: Prime Health Services Medicare |
$157.88
|
| Rate for Payer: Prime Health Services Medicare |
$157.88
|
| Rate for Payer: Riverside University Health System MISP |
$163.83
|
| Rate for Payer: Riverside University Health System MISP |
$163.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,894.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,738.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,738.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,894.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,567.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,095.56
|
| Rate for Payer: United Healthcare All Other HMO |
$10,285.64
|
| Rate for Payer: United Healthcare All Other HMO |
$10,799.92
|
| Rate for Payer: United Healthcare HMO Rider |
$10,566.36
|
| Rate for Payer: United Healthcare HMO Rider |
$10,063.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,682.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,221.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$148.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$148.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.83
|
| Rate for Payer: Vantage Medical Group Senior |
$163.83
|
| Rate for Payer: Vantage Medical Group Senior |
$163.83
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [208788]
|
Facility
|
OP
|
$12,835.98
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.82 |
| Max. Negotiated Rate |
$11,552.38 |
| Rate for Payer: Adventist Health Commercial |
$2,567.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,058.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,320.95
|
| Rate for Payer: Blue Shield of California Commercial |
$705.98
|
| Rate for Payer: Blue Shield of California EPN |
$641.80
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Central Health Plan Commercial |
$10,268.78
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,985.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.33
|
| Rate for Payer: EPIC Health Plan Senior |
$157.55
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,552.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$234.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,150.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,567.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.93
|
| Rate for Payer: Multiplan Commercial |
$9,626.99
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.23
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
| Rate for Payer: Prime Health Services Medicare |
$151.82
|
| Rate for Payer: Riverside University Health System MISP |
$157.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,701.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,701.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,817.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,688.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4,587.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,203.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.55
|
| Rate for Payer: Vantage Medical Group Senior |
$157.55
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [208788]
|
Facility
|
IP
|
$12,835.98
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,567.20 |
| Max. Negotiated Rate |
$11,552.38 |
| Rate for Payer: Adventist Health Commercial |
$2,567.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,294.46
|
| Rate for Payer: Blue Shield of California EPN |
$6,469.33
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Central Health Plan Commercial |
$10,268.78
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,985.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,134.39
|
| Rate for Payer: EPIC Health Plan Senior |
$5,134.39
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,552.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,150.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,573.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,567.20
|
| Rate for Payer: Multiplan Commercial |
$9,626.99
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,817.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,688.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4,587.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,203.78
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [32267]
|
Facility
|
IP
|
$12,835.98
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,567.20 |
| Max. Negotiated Rate |
$11,552.38 |
| Rate for Payer: Adventist Health Commercial |
$2,567.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,294.46
|
| Rate for Payer: Blue Shield of California EPN |
$6,469.33
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Central Health Plan Commercial |
$10,268.78
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,985.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,134.39
|
| Rate for Payer: EPIC Health Plan Senior |
$5,134.39
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,552.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,150.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,573.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,567.20
|
| Rate for Payer: Multiplan Commercial |
$9,626.99
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,817.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,688.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4,587.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,203.78
|
|
|
PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [32267]
|
Facility
|
OP
|
$12,835.98
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.82 |
| Max. Negotiated Rate |
$11,552.38 |
| Rate for Payer: Adventist Health Commercial |
$2,567.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,058.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,320.95
|
| Rate for Payer: Blue Shield of California Commercial |
$705.98
|
| Rate for Payer: Blue Shield of California EPN |
$641.80
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Cash Price |
$5,776.19
|
| Rate for Payer: Central Health Plan Commercial |
$10,268.78
|
| Rate for Payer: Cigna of CA HMO |
$8,985.19
|
| Rate for Payer: Cigna of CA PPO |
$8,985.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,985.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.33
|
| Rate for Payer: EPIC Health Plan Senior |
$157.55
|
| Rate for Payer: Galaxy Health WC |
$10,910.58
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,552.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$234.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,150.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,567.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.93
|
| Rate for Payer: Multiplan Commercial |
$9,626.99
|
| Rate for Payer: Networks By Design Commercial |
$6,417.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.23
|
| Rate for Payer: Prime Health Services Commercial |
$10,910.58
|
| Rate for Payer: Prime Health Services Medicare |
$151.82
|
| Rate for Payer: Riverside University Health System MISP |
$157.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,701.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,701.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,817.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,688.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4,587.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,203.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.55
|
| Rate for Payer: Vantage Medical Group Senior |
$157.55
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS AUTO-INJECTOR [237958]
|
Facility
|
IP
|
$8,350.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,670.00 |
| Max. Negotiated Rate |
$7,515.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,696.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,208.40
|
| Rate for Payer: Cash Price |
$3,757.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,680.00
|
| Rate for Payer: Cigna of CA HMO |
$5,845.00
|
| Rate for Payer: Cigna of CA PPO |
$5,845.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,845.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,340.00
|
| Rate for Payer: Galaxy Health WC |
$7,097.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,010.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,515.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,302.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,926.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.00
|
| Rate for Payer: Multiplan Commercial |
$6,262.50
|
| Rate for Payer: Networks By Design Commercial |
$4,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,097.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,133.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3,050.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,984.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,734.62
|
|
|
PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS AUTO-INJECTOR [237958]
|
Facility
|
OP
|
$8,350.00
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.13 |
| Max. Negotiated Rate |
$7,515.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$149.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,013.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$859.29
|
| Rate for Payer: Blue Shield of California Commercial |
$459.25
|
| Rate for Payer: Blue Shield of California EPN |
$417.50
|
| Rate for Payer: Cash Price |
$3,757.50
|
| Rate for Payer: Cash Price |
$3,757.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,680.00
|
| Rate for Payer: Cigna of CA HMO |
$5,845.00
|
| Rate for Payer: Cigna of CA PPO |
$5,845.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,845.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.06
|
| Rate for Payer: EPIC Health Plan Senior |
$164.04
|
| Rate for Payer: Galaxy Health WC |
$7,097.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,010.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,515.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$244.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,302.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$208.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$199.83
|
| Rate for Payer: Multiplan Commercial |
$6,262.50
|
| Rate for Payer: Networks By Design Commercial |
$4,175.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$149.13
|
| Rate for Payer: Prime Health Services Commercial |
$7,097.50
|
| Rate for Payer: Prime Health Services Medicare |
$158.08
|
| Rate for Payer: Riverside University Health System MISP |
$164.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,010.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,010.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,133.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3,050.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2,984.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,734.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$149.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.04
|
| Rate for Payer: Vantage Medical Group Senior |
$164.04
|
|
|
PEGLOTICASE 8 MG/50 ML INTRAVENOUS SOLUTION [247708]
|
Facility
|
IP
|
$788.86
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.77 |
| Max. Negotiated Rate |
$709.97 |
| Rate for Payer: Adventist Health Commercial |
$157.77
|
| Rate for Payer: Blue Shield of California Commercial |
$632.67
|
| Rate for Payer: Blue Shield of California EPN |
$397.59
|
| Rate for Payer: Cash Price |
$354.99
|
| Rate for Payer: Central Health Plan Commercial |
$631.09
|
| Rate for Payer: Cigna of CA HMO |
$552.20
|
| Rate for Payer: Cigna of CA PPO |
$552.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$552.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.54
|
| Rate for Payer: EPIC Health Plan Senior |
$315.54
|
| Rate for Payer: Galaxy Health WC |
$670.53
|
| Rate for Payer: Global Benefits Group Commercial |
$473.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$465.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.77
|
| Rate for Payer: Multiplan Commercial |
$591.64
|
| Rate for Payer: Networks By Design Commercial |
$394.43
|
| Rate for Payer: Prime Health Services Commercial |
$670.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$296.06
|
| Rate for Payer: United Healthcare All Other HMO |
$288.17
|
| Rate for Payer: United Healthcare HMO Rider |
$281.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.35
|
|
|
PEGLOTICASE 8 MG/50 ML INTRAVENOUS SOLUTION [247708]
|
Facility
|
OP
|
$788.86
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.77 |
| Max. Negotiated Rate |
$22,094.47 |
| Rate for Payer: Adventist Health Commercial |
$157.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,929.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22,094.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,911.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,322.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$569.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4,837.60
|
| Rate for Payer: Blue Shield of California EPN |
$4,397.82
|
| Rate for Payer: Cash Price |
$354.99
|
| Rate for Payer: Cash Price |
$354.99
|
| Rate for Payer: Central Health Plan Commercial |
$631.09
|
| Rate for Payer: Cigna of CA HMO |
$552.20
|
| Rate for Payer: Cigna of CA PPO |
$552.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,911.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,322.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,322.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$552.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,483.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4,322.27
|
| Rate for Payer: Galaxy Health WC |
$670.53
|
| Rate for Payer: Global Benefits Group Commercial |
$473.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$709.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,444.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,929.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,929.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$500.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,160.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,265.32
|
| Rate for Payer: Multiplan Commercial |
$591.64
|
| Rate for Payer: Networks By Design Commercial |
$394.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,929.34
|
| Rate for Payer: Prime Health Services Commercial |
$670.53
|
| Rate for Payer: Prime Health Services Medicare |
$4,165.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,322.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$473.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$473.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$296.06
|
| Rate for Payer: United Healthcare All Other HMO |
$288.17
|
| Rate for Payer: United Healthcare HMO Rider |
$281.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,929.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,911.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,322.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.27
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION [107664]
|
Facility
|
OP
|
$39,442.86
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$569.03 |
| Max. Negotiated Rate |
$35,498.57 |
| Rate for Payer: Adventist Health Commercial |
$7,888.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,929.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22,094.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,911.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,322.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$569.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4,837.60
|
| Rate for Payer: Blue Shield of California EPN |
$4,397.82
|
| Rate for Payer: Cash Price |
$17,749.29
|
| Rate for Payer: Cash Price |
$17,749.29
|
| Rate for Payer: Central Health Plan Commercial |
$31,554.29
|
| Rate for Payer: Cigna of CA HMO |
$27,610.00
|
| Rate for Payer: Cigna of CA PPO |
$27,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,911.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,322.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,322.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,483.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4,322.27
|
| Rate for Payer: Galaxy Health WC |
$33,526.43
|
| Rate for Payer: Global Benefits Group Commercial |
$23,665.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,498.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,444.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,929.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,929.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,046.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,160.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,888.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,265.32
|
| Rate for Payer: Multiplan Commercial |
$29,582.15
|
| Rate for Payer: Networks By Design Commercial |
$19,721.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,929.34
|
| Rate for Payer: Prime Health Services Commercial |
$33,526.43
|
| Rate for Payer: Prime Health Services Medicare |
$4,165.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,322.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,665.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,665.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,802.91
|
| Rate for Payer: United Healthcare All Other HMO |
$14,408.48
|
| Rate for Payer: United Healthcare HMO Rider |
$14,096.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,917.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,929.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,911.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,322.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.27
|
|
|
PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION [107664]
|
Facility
|
IP
|
$39,442.86
|
|
|
Service Code
|
HCPCS J2507
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,888.57 |
| Max. Negotiated Rate |
$35,498.57 |
| Rate for Payer: Adventist Health Commercial |
$7,888.57
|
| Rate for Payer: Blue Shield of California Commercial |
$31,633.17
|
| Rate for Payer: Blue Shield of California EPN |
$19,879.20
|
| Rate for Payer: Cash Price |
$17,749.29
|
| Rate for Payer: Central Health Plan Commercial |
$31,554.29
|
| Rate for Payer: Cigna of CA HMO |
$27,610.00
|
| Rate for Payer: Cigna of CA PPO |
$27,610.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,777.14
|
| Rate for Payer: EPIC Health Plan Senior |
$15,777.14
|
| Rate for Payer: Galaxy Health WC |
$33,526.43
|
| Rate for Payer: Global Benefits Group Commercial |
$23,665.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,498.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,046.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,271.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,888.57
|
| Rate for Payer: Multiplan Commercial |
$29,582.15
|
| Rate for Payer: Networks By Design Commercial |
$19,721.43
|
| Rate for Payer: Prime Health Services Commercial |
$33,526.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,802.91
|
| Rate for Payer: United Healthcare All Other HMO |
$14,408.48
|
| Rate for Payer: United Healthcare HMO Rider |
$14,096.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,917.54
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$56,059.47
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$56,059.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,059.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36,212.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50,698.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,959.79
|
| Rate for Payer: EPIC Health Plan Senior |
$33,306.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,278.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,390.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,573.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,278.66
|
| Rate for Payer: Prime Health Services Medicare |
$32,095.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$35,412.21
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$19,458.80 |
| Max. Negotiated Rate |
$35,412.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,412.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,874.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,025.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,107.02
|
| Rate for Payer: EPIC Health Plan Senior |
$21,404.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,458.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,242.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,074.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,458.80
|
| Rate for Payer: Prime Health Services Medicare |
$20,626.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,996.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24,996.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,398.00
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [208822]
|
Facility
|
OP
|
$1,840.80
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.65 |
| Max. Negotiated Rate |
$1,656.72 |
| Rate for Payer: Adventist Health Commercial |
$368.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.61
|
| Rate for Payer: Blue Shield of California Commercial |
$76.32
|
| Rate for Payer: Blue Shield of California EPN |
$69.38
|
| Rate for Payer: Cash Price |
$828.36
|
| Rate for Payer: Cash Price |
$828.36
|
| Rate for Payer: Central Health Plan Commercial |
$1,472.64
|
| Rate for Payer: Cigna of CA HMO |
$1,288.56
|
| Rate for Payer: Cigna of CA PPO |
$1,288.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,288.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.07
|
| Rate for Payer: EPIC Health Plan Senior |
$66.72
|
| Rate for Payer: Galaxy Health WC |
$1,564.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,656.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$99.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,168.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.27
|
| Rate for Payer: Multiplan Commercial |
$1,380.60
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.68
|
| Rate for Payer: Prime Health Services Medicare |
$64.29
|
| Rate for Payer: Riverside University Health System MISP |
$66.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,104.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,104.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.85
|
| Rate for Payer: United Healthcare All Other HMO |
$672.44
|
| Rate for Payer: United Healthcare HMO Rider |
$657.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$602.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.72
|
| Rate for Payer: Vantage Medical Group Senior |
$66.72
|
|
|
PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION [208822]
|
Facility
|
IP
|
$1,840.80
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$368.16 |
| Max. Negotiated Rate |
$1,656.72 |
| Rate for Payer: Adventist Health Commercial |
$368.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,476.32
|
| Rate for Payer: Blue Shield of California EPN |
$927.76
|
| Rate for Payer: Cash Price |
$828.36
|
| Rate for Payer: Central Health Plan Commercial |
$1,472.64
|
| Rate for Payer: Cigna of CA HMO |
$1,288.56
|
| Rate for Payer: Cigna of CA PPO |
$1,288.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,288.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.32
|
| Rate for Payer: EPIC Health Plan Senior |
$736.32
|
| Rate for Payer: Galaxy Health WC |
$1,564.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,656.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,168.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,086.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.16
|
| Rate for Payer: Multiplan Commercial |
$1,380.60
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.85
|
| Rate for Payer: United Healthcare All Other HMO |
$672.44
|
| Rate for Payer: United Healthcare HMO Rider |
$657.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$602.86
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION [89350]
|
Facility
|
OP
|
$190.80
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$171.72 |
| Rate for Payer: Adventist Health Commercial |
$38.16
|
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.37
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: Central Health Plan Commercial |
$152.64
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$133.56
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$133.56
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.47
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Galaxy Health WC |
$162.18
|
| Rate for Payer: Global Benefits Group Commercial |
$114.48
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$95.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.95
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.18
|
| Rate for Payer: Prime Health Services Medicare |
$7.37
|
| Rate for Payer: Prime Health Services Medicare |
$7.37
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.61
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare All Other HMO |
$69.70
|
| Rate for Payer: United Healthcare HMO Rider |
$68.19
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
|
|
PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION [89350]
|
Facility
|
IP
|
$190.80
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$171.72 |
| Rate for Payer: Adventist Health Commercial |
$38.16
|
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$153.02
|
| Rate for Payer: Blue Shield of California Commercial |
$120.30
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$96.16
|
| Rate for Payer: Cash Price |
$85.86
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.64
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA HMO |
$133.56
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$133.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.32
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.32
|
| Rate for Payer: Galaxy Health WC |
$162.18
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Global Benefits Group Commercial |
$114.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$95.40
|
| Rate for Payer: Prime Health Services Commercial |
$162.18
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.61
|
| Rate for Payer: United Healthcare All Other HMO |
$69.70
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare HMO Rider |
$68.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.49
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION [37894]
|
Facility
|
IP
|
$951.60
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$856.44 |
| Rate for Payer: Adventist Health Commercial |
$190.32
|
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$763.18
|
| Rate for Payer: Blue Shield of California Commercial |
$481.20
|
| Rate for Payer: Blue Shield of California EPN |
$302.40
|
| Rate for Payer: Blue Shield of California EPN |
$479.61
|
| Rate for Payer: Cash Price |
$428.22
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Central Health Plan Commercial |
$761.28
|
| Rate for Payer: Central Health Plan Commercial |
$480.00
|
| Rate for Payer: Cigna of CA HMO |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$666.12
|
| Rate for Payer: Cigna of CA PPO |
$420.00
|
| Rate for Payer: Cigna of CA PPO |
$666.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.64
|
| Rate for Payer: EPIC Health Plan Senior |
$240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$380.64
|
| Rate for Payer: Galaxy Health WC |
$808.86
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Global Benefits Group Commercial |
$570.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$354.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$713.70
|
| Rate for Payer: Networks By Design Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$808.86
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$357.14
|
| Rate for Payer: United Healthcare All Other HMO |
$347.62
|
| Rate for Payer: United Healthcare All Other HMO |
$219.18
|
| Rate for Payer: United Healthcare HMO Rider |
$214.44
|
| Rate for Payer: United Healthcare HMO Rider |
$340.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.65
|
|
|
PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION [37894]
|
Facility
|
OP
|
$951.60
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$856.44 |
| Rate for Payer: Adventist Health Commercial |
$190.32
|
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.37
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$428.22
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$428.22
|
| Rate for Payer: Central Health Plan Commercial |
$761.28
|
| Rate for Payer: Central Health Plan Commercial |
$480.00
|
| Rate for Payer: Cigna of CA HMO |
$666.12
|
| Rate for Payer: Cigna of CA HMO |
$420.00
|
| Rate for Payer: Cigna of CA PPO |
$666.12
|
| Rate for Payer: Cigna of CA PPO |
$420.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$420.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$666.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.47
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: EPIC Health Plan Senior |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$808.86
|
| Rate for Payer: Global Benefits Group Commercial |
$570.96
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$381.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$604.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$713.70
|
| Rate for Payer: Networks By Design Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.95
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Prime Health Services Commercial |
$808.86
|
| Rate for Payer: Prime Health Services Medicare |
$7.37
|
| Rate for Payer: Prime Health Services Medicare |
$7.37
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$570.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$570.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$357.14
|
| Rate for Payer: United Healthcare All Other HMO |
$219.18
|
| Rate for Payer: United Healthcare All Other HMO |
$347.62
|
| Rate for Payer: United Healthcare HMO Rider |
$340.10
|
| Rate for Payer: United Healthcare HMO Rider |
$214.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
|
|
PEMIGATINIB 13.5 MG TABLET [227743]
|
Facility
|
OP
|
$1,808.31
|
|
|
Service Code
|
NDC 5088102801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$361.66 |
| Max. Negotiated Rate |
$1,627.48 |
| Rate for Payer: Adventist Health Commercial |
$361.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,098.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$875.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.47
|
| Rate for Payer: Blue Shield of California EPN |
$721.52
|
| Rate for Payer: Cash Price |
$813.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.65
|
| Rate for Payer: Cigna of CA HMO |
$1,265.82
|
| Rate for Payer: Cigna of CA PPO |
$1,265.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,537.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,537.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.32
|
| Rate for Payer: EPIC Health Plan Senior |
$723.32
|
| Rate for Payer: Galaxy Health WC |
$1,537.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,265.82
|
| Rate for Payer: Multiplan Commercial |
$1,356.23
|
| Rate for Payer: Networks By Design Commercial |
$1,175.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.06
|
| Rate for Payer: Riverside University Health System MISP |
$723.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$904.15
|
| Rate for Payer: United Healthcare All Other HMO |
$904.15
|
| Rate for Payer: United Healthcare HMO Rider |
$904.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$904.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,537.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,537.06
|
|
|
PEMIGATINIB 13.5 MG TABLET [227743]
|
Facility
|
IP
|
$1,808.31
|
|
|
Service Code
|
NDC 5088102801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$361.66 |
| Max. Negotiated Rate |
$1,627.48 |
| Rate for Payer: Adventist Health Commercial |
$361.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.26
|
| Rate for Payer: Blue Shield of California EPN |
$911.39
|
| Rate for Payer: Cash Price |
$813.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.65
|
| Rate for Payer: Cigna of CA HMO |
$1,265.82
|
| Rate for Payer: Cigna of CA PPO |
$1,265.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.32
|
| Rate for Payer: EPIC Health Plan Senior |
$723.32
|
| Rate for Payer: Galaxy Health WC |
$1,537.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.66
|
| Rate for Payer: Multiplan Commercial |
$1,356.23
|
| Rate for Payer: Networks By Design Commercial |
$1,175.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.06
|
|
|
PEMIGATINIB 4.5 MG TABLET [227741]
|
Facility
|
OP
|
$1,808.31
|
|
|
Service Code
|
NDC 5088102601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$361.66 |
| Max. Negotiated Rate |
$1,627.48 |
| Rate for Payer: Adventist Health Commercial |
$361.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,098.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$875.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.47
|
| Rate for Payer: Blue Shield of California EPN |
$721.52
|
| Rate for Payer: Cash Price |
$813.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.65
|
| Rate for Payer: Cigna of CA HMO |
$1,265.82
|
| Rate for Payer: Cigna of CA PPO |
$1,265.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,537.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,537.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.32
|
| Rate for Payer: EPIC Health Plan Senior |
$723.32
|
| Rate for Payer: Galaxy Health WC |
$1,537.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,265.82
|
| Rate for Payer: Multiplan Commercial |
$1,356.23
|
| Rate for Payer: Networks By Design Commercial |
$1,175.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.06
|
| Rate for Payer: Riverside University Health System MISP |
$723.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$904.15
|
| Rate for Payer: United Healthcare All Other HMO |
$904.15
|
| Rate for Payer: United Healthcare HMO Rider |
$904.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$904.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,537.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,537.06
|
|
|
PEMIGATINIB 4.5 MG TABLET [227741]
|
Facility
|
IP
|
$1,808.31
|
|
|
Service Code
|
NDC 5088102601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$361.66 |
| Max. Negotiated Rate |
$1,627.48 |
| Rate for Payer: Adventist Health Commercial |
$361.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.26
|
| Rate for Payer: Blue Shield of California EPN |
$911.39
|
| Rate for Payer: Cash Price |
$813.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.65
|
| Rate for Payer: Cigna of CA HMO |
$1,265.82
|
| Rate for Payer: Cigna of CA PPO |
$1,265.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.32
|
| Rate for Payer: EPIC Health Plan Senior |
$723.32
|
| Rate for Payer: Galaxy Health WC |
$1,537.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.66
|
| Rate for Payer: Multiplan Commercial |
$1,356.23
|
| Rate for Payer: Networks By Design Commercial |
$1,175.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.06
|
|
|
PEMIGATINIB 9 MG TABLET [227742]
|
Facility
|
IP
|
$1,808.31
|
|
|
Service Code
|
NDC 5088102701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$361.66 |
| Max. Negotiated Rate |
$1,627.48 |
| Rate for Payer: Adventist Health Commercial |
$361.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,450.26
|
| Rate for Payer: Blue Shield of California EPN |
$911.39
|
| Rate for Payer: Cash Price |
$813.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.65
|
| Rate for Payer: Cigna of CA HMO |
$1,265.82
|
| Rate for Payer: Cigna of CA PPO |
$1,265.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.32
|
| Rate for Payer: EPIC Health Plan Senior |
$723.32
|
| Rate for Payer: Galaxy Health WC |
$1,537.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.66
|
| Rate for Payer: Multiplan Commercial |
$1,356.23
|
| Rate for Payer: Networks By Design Commercial |
$1,175.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.06
|
|
|
PEMIGATINIB 9 MG TABLET [227742]
|
Facility
|
OP
|
$1,808.31
|
|
|
Service Code
|
NDC 5088102701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$361.66 |
| Max. Negotiated Rate |
$1,627.48 |
| Rate for Payer: Adventist Health Commercial |
$361.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,098.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$875.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.47
|
| Rate for Payer: Blue Shield of California EPN |
$721.52
|
| Rate for Payer: Cash Price |
$813.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.65
|
| Rate for Payer: Cigna of CA HMO |
$1,265.82
|
| Rate for Payer: Cigna of CA PPO |
$1,265.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,537.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,537.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,265.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.32
|
| Rate for Payer: EPIC Health Plan Senior |
$723.32
|
| Rate for Payer: Galaxy Health WC |
$1,537.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,148.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,066.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,265.82
|
| Rate for Payer: Multiplan Commercial |
$1,356.23
|
| Rate for Payer: Networks By Design Commercial |
$1,175.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,537.06
|
| Rate for Payer: Riverside University Health System MISP |
$723.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$904.15
|
| Rate for Payer: United Healthcare All Other HMO |
$904.15
|
| Rate for Payer: United Healthcare HMO Rider |
$904.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$904.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,537.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,537.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,537.06
|
|
