|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 0378-0771-01
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Riverside University Health MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
OP
|
$0.07
|
|
|
Service Code
|
NDC 43547-399-10
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: IEHP medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 68084-753-25
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.07
|
|
|
Service Code
|
NDC 43547-399-10
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
OP
|
$0.82
|
|
|
Service Code
|
NDC 50268-190-11
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.62
|
| Rate for Payer: IEHP medi-cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: Riverside University Health MISP |
$0.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 0378-0771-01
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Central Health Plan Commercial |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68084-753-95
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
OP
|
$0.60
|
|
|
Service Code
|
NDC 68084-753-95
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: BCBS Transplant Transplant |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.45
|
| Rate for Payer: IEHP medi-cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.82
|
|
|
Service Code
|
NDC 50268-190-11
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Galaxy Health WC |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 69097-845-07
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
CYCLOBENZAPRINE 5 MG TABLET [35184]
|
Facility
IP
|
$0.60
|
|
|
Service Code
|
NDC 68084-753-25
|
| Hospital Charge Code |
1712380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.51
|
| Rate for Payer: Global Benefits Group Commercial |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.39
|
| Rate for Payer: Prime Health Services Commercial |
$0.51
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
NDC 61314-396-03
|
| Hospital Charge Code |
1740075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
OP
|
$2.24
|
|
|
Service Code
|
NDC 61314-396-03
|
| Hospital Charge Code |
1740075
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: BCBS Transplant Transplant |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.68
|
| Rate for Payer: IEHP medi-cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: Riverside University Health MISP |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
IP
|
$7.17
|
|
|
Service Code
|
NDC 61314-396-01
|
| Hospital Charge Code |
1740068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Central Health Plan Commercial |
$5.74
|
| Rate for Payer: Cigna of CA HMO |
$5.02
|
| Rate for Payer: Cigna of CA PPO |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.66
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS [2025]
|
Facility
OP
|
$7.17
|
|
|
Service Code
|
NDC 61314-396-01
|
| Hospital Charge Code |
1740068
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.24
|
| Rate for Payer: BCBS Transplant Transplant |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Central Health Plan Commercial |
$5.74
|
| Rate for Payer: Cigna of CA HMO |
$5.02
|
| Rate for Payer: Cigna of CA PPO |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$6.09
|
| Rate for Payer: Global Benefits Group Commercial |
$4.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.38
|
| Rate for Payer: IEHP medi-cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.66
|
| Rate for Payer: Prime Health Services Commercial |
$6.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: Riverside University Health MISP |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Vantage Medical Group Senior |
$6.09
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]
|
Facility
OP
|
$19.96
|
|
|
Service Code
|
NDC 0065-0359-02
|
| Hospital Charge Code |
1740343
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.79
|
| Rate for Payer: BCBS Transplant Transplant |
$11.98
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Central Health Plan Commercial |
$15.97
|
| Rate for Payer: Cigna of CA HMO |
$12.77
|
| Rate for Payer: Cigna of CA PPO |
$14.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.97
|
| Rate for Payer: IEHP medi-cal |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$14.97
|
| Rate for Payer: Networks By Design Commercial |
$12.97
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
| Rate for Payer: Riverside University Health MISP |
$7.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Other HMO |
$9.98
|
| Rate for Payer: United Healthcare HMO Rider |
$9.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.97
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS [9701]
|
Facility
IP
|
$19.96
|
|
|
Service Code
|
NDC 0065-0359-02
|
| Hospital Charge Code |
1740343
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.97
|
| Rate for Payer: Blue Shield of California EPN |
$10.66
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Central Health Plan Commercial |
$15.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$14.97
|
| Rate for Payer: Networks By Design Commercial |
$12.97
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
|
|
CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
IP
|
$791.10
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$504.32
|
| Rate for Payer: Blue Shield of California Commercial |
$659.25
|
| Rate for Payer: Blue Shield of California Commercial |
$593.32
|
| Rate for Payer: Blue Shield of California EPN |
$359.08
|
| Rate for Payer: Blue Shield of California EPN |
$422.45
|
| Rate for Payer: Blue Shield of California EPN |
$469.39
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Central Health Plan Commercial |
$703.20
|
| Rate for Payer: Central Health Plan Commercial |
$537.94
|
| Rate for Payer: Central Health Plan Commercial |
$632.88
|
| Rate for Payer: Cigna of CA HMO |
$553.77
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA HMO |
$615.30
|
| Rate for Payer: Cigna of CA PPO |
$553.77
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| Rate for Payer: Cigna of CA PPO |
$615.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$268.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$351.60
|
| Rate for Payer: Galaxy Health WC |
$672.44
|
| Rate for Payer: Galaxy Health WC |
$571.57
|
| Rate for Payer: Galaxy Health WC |
$747.15
|
| Rate for Payer: Global Benefits Group Commercial |
$403.46
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Global Benefits Group Commercial |
$474.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$711.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$791.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.80
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan Commercial |
$593.32
|
| Rate for Payer: Multiplan Commercial |
$504.32
|
| Rate for Payer: Networks By Design Commercial |
$395.55
|
| Rate for Payer: Networks By Design Commercial |
$336.22
|
| Rate for Payer: Networks By Design Commercial |
$439.50
|
| Rate for Payer: Prime Health Services Commercial |
$571.57
|
| Rate for Payer: Prime Health Services Commercial |
$747.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.44
|
|
|
CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION [38270]
|
Facility
OP
|
$672.43
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$605.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: BCBS Transplant Transplant |
$474.66
|
| Rate for Payer: BCBS Transplant Transplant |
$527.40
|
| Rate for Payer: BCBS Transplant Transplant |
$403.46
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$302.59
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Central Health Plan Commercial |
$632.88
|
| Rate for Payer: Central Health Plan Commercial |
$537.94
|
| Rate for Payer: Central Health Plan Commercial |
$703.20
|
| Rate for Payer: Cigna of CA HMO |
$470.70
|
| Rate for Payer: Cigna of CA HMO |
$553.77
|
| Rate for Payer: Cigna of CA HMO |
$615.30
|
| Rate for Payer: Cigna of CA PPO |
$553.77
|
| Rate for Payer: Cigna of CA PPO |
$470.70
|
| Rate for Payer: Cigna of CA PPO |
$615.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$672.44
|
| Rate for Payer: Galaxy Health WC |
$571.57
|
| Rate for Payer: Galaxy Health WC |
$747.15
|
| Rate for Payer: Global Benefits Group Commercial |
$403.46
|
| Rate for Payer: Global Benefits Group Commercial |
$474.66
|
| Rate for Payer: Global Benefits Group Commercial |
$527.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$791.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$711.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$593.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$504.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$659.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Multiplan Commercial |
$504.32
|
| Rate for Payer: Multiplan Commercial |
$593.32
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Networks By Design Commercial |
$336.22
|
| Rate for Payer: Networks By Design Commercial |
$395.55
|
| Rate for Payer: Networks By Design Commercial |
$439.50
|
| Rate for Payer: Prime Health Services Commercial |
$571.57
|
| Rate for Payer: Prime Health Services Commercial |
$747.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.44
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$527.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$527.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$439.50
|
| Rate for Payer: United Healthcare All Other HMO |
$336.22
|
| Rate for Payer: United Healthcare All Other HMO |
$395.55
|
| Rate for Payer: United Healthcare All Other HMO |
$439.50
|
| Rate for Payer: United Healthcare HMO Rider |
$395.55
|
| Rate for Payer: United Healthcare HMO Rider |
$336.22
|
| Rate for Payer: United Healthcare HMO Rider |
$439.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$439.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
IP
|
$4.04
|
|
|
Service Code
|
CPT J8530
|
| Hospital Charge Code |
ERX206105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.23
|
| Rate for Payer: Cigna of CA HMO |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
|
|
CYCLOPHOSPHAMIDE 25 MG CAPSULE [206105]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J8530
|
| Hospital Charge Code |
ERX206105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.51
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$2.42
|
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$3.23
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.62
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$3.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: IEHP medi-cal |
$0.96
|
| Rate for Payer: IEHP medi-cal |
$0.96
|
| Rate for Payer: IEHP medi-cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$3.03
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.02
|
| Rate for Payer: Prime Health Services Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Riverside University Health MISP |
$1.62
|
| Rate for Payer: Riverside University Health MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3.43
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
OP
|
$1,758.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: BCBS Transplant Transplant |
$1,054.80
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: Cigna of CA HMO |
$1,230.60
|
| Rate for Payer: Cigna of CA PPO |
$1,230.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,318.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$879.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,054.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other HMO |
$879.00
|
| Rate for Payer: United Healthcare HMO Rider |
$879.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$879.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
CYCLOPHOSPHAMIDE 2 GRAM INTRAVENOUS POWDER FOR SOLUTION [28922]
|
Facility
IP
|
$1,758.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
1755757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,318.50
|
| Rate for Payer: Blue Shield of California EPN |
$938.77
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,406.40
|
| Rate for Payer: Cigna of CA HMO |
$1,230.60
|
| Rate for Payer: Cigna of CA PPO |
$1,230.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$703.20
|
| Rate for Payer: Galaxy Health WC |
$1,494.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,582.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,172.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: Networks By Design Commercial |
$879.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,494.30
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
IP
|
$222.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
ERX38271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$166.50
|
| Rate for Payer: Blue Shield of California Commercial |
$329.62
|
| Rate for Payer: Blue Shield of California Commercial |
$252.17
|
| Rate for Payer: Blue Shield of California EPN |
$234.69
|
| Rate for Payer: Blue Shield of California EPN |
$118.55
|
| Rate for Payer: Blue Shield of California EPN |
$179.55
|
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Central Health Plan Commercial |
$268.98
|
| Rate for Payer: Central Health Plan Commercial |
$351.60
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA HMO |
$307.65
|
| Rate for Payer: Cigna of CA PPO |
$307.65
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$373.58
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Global Benefits Group Commercial |
$263.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$252.17
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$329.62
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Networks By Design Commercial |
$219.75
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: Prime Health Services Commercial |
$373.58
|
|
|
CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION [38271]
|
Facility
OP
|
$222.00
|
|
|
Service Code
|
CPT J9070
|
| Hospital Charge Code |
ERX38271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: BCBS Transplant Transplant |
$133.20
|
| Rate for Payer: BCBS Transplant Transplant |
$263.70
|
| Rate for Payer: BCBS Transplant Transplant |
$201.74
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California Commercial |
$88.07
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Blue Shield of California EPN |
$80.06
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Cash Price |
$197.78
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$151.30
|
| Rate for Payer: Central Health Plan Commercial |
$268.98
|
| Rate for Payer: Central Health Plan Commercial |
$351.60
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA HMO |
$235.36
|
| Rate for Payer: Cigna of CA HMO |
$307.65
|
| Rate for Payer: Cigna of CA PPO |
$307.65
|
| Rate for Payer: Cigna of CA PPO |
$235.36
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$285.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Galaxy Health WC |
$373.58
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Global Benefits Group Commercial |
$263.70
|
| Rate for Payer: Global Benefits Group Commercial |
$201.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$166.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$329.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Innovage PACE Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.01
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$252.17
|
| Rate for Payer: Multiplan Commercial |
$329.62
|
| Rate for Payer: Networks By Design Commercial |
$219.75
|
| Rate for Payer: Networks By Design Commercial |
$168.12
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$373.58
|
| Rate for Payer: Prime Health Services Commercial |
$285.80
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Riverside University Health MISP |
$22.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$263.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$263.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.12
|
| Rate for Payer: United Healthcare All Other HMO |
$219.75
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.12
|
| Rate for Payer: United Healthcare HMO Rider |
$219.75
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
