|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
IP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
1715018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| 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 |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.83
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Central Health Plan Commercial |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.50
|
|
|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
OP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
1715018
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.13
|
| Rate for Payer: BCBS Transplant Transplant |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.59
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Central Health Plan Commercial |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$3.71
|
| Rate for Payer: Cigna of CA PPO |
$3.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.98
|
| Rate for Payer: IEHP medi-cal |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$3.44
|
| Rate for Payer: Prime Health Services Commercial |
$4.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.18
|
| Rate for Payer: Riverside University Health MISP |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.65
|
| Rate for Payer: United Healthcare All Other HMO |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.50
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
IP
|
$140.87
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
NDG216389
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.17 |
| 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 |
$105.65
|
| Rate for Payer: Blue Shield of California EPN |
$75.22
|
| Rate for Payer: Cash Price |
$63.39
|
| Rate for Payer: Cash Price |
$63.39
|
| Rate for Payer: Central Health Plan Commercial |
$112.70
|
| Rate for Payer: Cigna of CA HMO |
$98.61
|
| Rate for Payer: Cigna of CA PPO |
$98.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.35
|
| Rate for Payer: Galaxy Health WC |
$119.74
|
| Rate for Payer: Global Benefits Group Commercial |
$84.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.17
|
| Rate for Payer: Multiplan Commercial |
$105.65
|
| Rate for Payer: Networks By Design Commercial |
$91.57
|
| Rate for Payer: Prime Health Services Commercial |
$119.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
OP
|
$140.87
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
NDG216389
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.23
|
| Rate for Payer: BCBS Transplant Transplant |
$84.52
|
| Rate for Payer: Blue Shield of California Commercial |
$88.61
|
| Rate for Payer: Blue Shield of California EPN |
$68.89
|
| Rate for Payer: Cash Price |
$63.39
|
| Rate for Payer: Central Health Plan Commercial |
$112.70
|
| Rate for Payer: Cigna of CA HMO |
$98.61
|
| Rate for Payer: Cigna of CA PPO |
$98.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.35
|
| Rate for Payer: Galaxy Health WC |
$119.74
|
| Rate for Payer: Global Benefits Group Commercial |
$84.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.65
|
| Rate for Payer: IEHP medi-cal |
$49.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.17
|
| Rate for Payer: Multiplan Commercial |
$105.65
|
| Rate for Payer: Networks By Design Commercial |
$91.57
|
| Rate for Payer: Prime Health Services Commercial |
$119.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$84.52
|
| Rate for Payer: Riverside University Health MISP |
$56.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.44
|
| Rate for Payer: United Healthcare All Other HMO |
$70.44
|
| Rate for Payer: United Healthcare HMO Rider |
$70.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$119.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
OP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
1740336
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.31
|
| Rate for Payer: BCBS Transplant Transplant |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.20
|
| Rate for Payer: IEHP medi-cal |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: Riverside University Health MISP |
$2.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
IP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
1740336
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| 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 |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Central Health Plan Commercial |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$3.92
|
| Rate for Payer: Cigna of CA PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Galaxy Health WC |
$4.76
|
| Rate for Payer: Global Benefits Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.76
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
OP
|
$14.74
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1711475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: BCBS Transplant Transplant |
$12.14
|
| Rate for Payer: BCBS Transplant Transplant |
$8.84
|
| Rate for Payer: BCBS Transplant Transplant |
$12.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$11.79
|
| Rate for Payer: Central Health Plan Commercial |
$16.22
|
| Rate for Payer: Central Health Plan Commercial |
$16.19
|
| Rate for Payer: Cigna of CA HMO |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$10.32
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Cigna of CA PPO |
$14.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.11
|
| Rate for Payer: Galaxy Health WC |
$17.23
|
| Rate for Payer: Galaxy Health WC |
$12.53
|
| Rate for Payer: Galaxy Health WC |
$17.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.14
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.20
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$15.18
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$7.37
|
| Rate for Payer: Prime Health Services Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.20
|
| Rate for Payer: Riverside University Health MISP |
$8.11
|
| Rate for Payer: Riverside University Health MISP |
$8.10
|
| Rate for Payer: Riverside University Health MISP |
$5.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.14
|
| Rate for Payer: United Healthcare All Other HMO |
$7.37
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$7.37
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.20
|
| Rate for Payer: Vantage Medical Group Senior |
$17.23
|
| Rate for Payer: Vantage Medical Group Senior |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$17.20
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
IP
|
$20.24
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1711475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| 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 |
$15.18
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$15.20
|
| Rate for Payer: Blue Shield of California EPN |
$10.81
|
| Rate for Payer: Blue Shield of California EPN |
$10.82
|
| Rate for Payer: Blue Shield of California EPN |
$7.87
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$11.79
|
| Rate for Payer: Central Health Plan Commercial |
$16.19
|
| Rate for Payer: Central Health Plan Commercial |
$16.22
|
| Rate for Payer: Cigna of CA HMO |
$14.19
|
| Rate for Payer: Cigna of CA HMO |
$10.32
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Cigna of CA PPO |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$12.53
|
| Rate for Payer: Galaxy Health WC |
$17.23
|
| Rate for Payer: Galaxy Health WC |
$17.20
|
| Rate for Payer: Global Benefits Group Commercial |
$12.16
|
| Rate for Payer: Global Benefits Group Commercial |
$8.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Networks By Design Commercial |
$10.12
|
| Rate for Payer: Prime Health Services Commercial |
$12.53
|
| Rate for Payer: Prime Health Services Commercial |
$17.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.23
|
|
|
CYCLOSPORINE 100 MG/ML ORAL SOLUTION [9708]
|
Facility
IP
|
$19.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1719136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| 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 |
$14.74
|
| Rate for Payer: Blue Shield of California EPN |
$10.50
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Central Health Plan Commercial |
$15.73
|
| Rate for Payer: Cigna of CA HMO |
$13.76
|
| Rate for Payer: Cigna of CA PPO |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$16.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.71
|
|
|
CYCLOSPORINE 100 MG/ML ORAL SOLUTION [9708]
|
Facility
OP
|
$19.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1719136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$17.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: BCBS Transplant Transplant |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Central Health Plan Commercial |
$15.73
|
| Rate for Payer: Cigna of CA HMO |
$13.76
|
| Rate for Payer: Cigna of CA PPO |
$13.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.86
|
| Rate for Payer: Galaxy Health WC |
$16.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.74
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: Networks By Design Commercial |
$9.83
|
| Rate for Payer: Prime Health Services Commercial |
$16.71
|
| Rate for Payer: Riverside University Health MISP |
$7.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Other HMO |
$9.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.71
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
OP
|
$15.78
|
|
|
Service Code
|
CPT J7516
|
| Hospital Charge Code |
NDG9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$238.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$238.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.57
|
| Rate for Payer: BCBS Transplant Transplant |
$5.63
|
| Rate for Payer: BCBS Transplant Transplant |
$9.47
|
| Rate for Payer: Blue Shield of California Commercial |
$51.62
|
| Rate for Payer: Blue Shield of California Commercial |
$51.62
|
| Rate for Payer: Blue Shield of California EPN |
$46.93
|
| Rate for Payer: Blue Shield of California EPN |
$46.93
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.51
|
| Rate for Payer: Central Health Plan Commercial |
$12.62
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.31
|
| Rate for Payer: Galaxy Health WC |
$13.41
|
| Rate for Payer: Galaxy Health WC |
$7.98
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.04
|
| Rate for Payer: IEHP medi-cal |
$3.29
|
| Rate for Payer: IEHP medi-cal |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$11.84
|
| Rate for Payer: Multiplan Commercial |
$7.04
|
| Rate for Payer: Networks By Design Commercial |
$4.70
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Commercial |
$7.98
|
| Rate for Payer: Prime Health Services Commercial |
$13.41
|
| Rate for Payer: Riverside University Health MISP |
$6.31
|
| Rate for Payer: Riverside University Health MISP |
$3.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$4.70
|
| Rate for Payer: United Healthcare HMO Rider |
$7.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.41
|
| Rate for Payer: Vantage Medical Group Senior |
$13.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.98
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
IP
|
$15.78
|
|
|
Service Code
|
CPT J7516
|
| Hospital Charge Code |
NDG9705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.16 |
| 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: Blue Shield of California Commercial |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$11.84
|
| Rate for Payer: Blue Shield of California EPN |
$8.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.01
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.62
|
| Rate for Payer: Central Health Plan Commercial |
$7.51
|
| Rate for Payer: Cigna of CA HMO |
$6.57
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$6.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.76
|
| Rate for Payer: Galaxy Health WC |
$7.98
|
| Rate for Payer: Galaxy Health WC |
$13.41
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$7.04
|
| Rate for Payer: Multiplan Commercial |
$11.84
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Networks By Design Commercial |
$4.70
|
| Rate for Payer: Prime Health Services Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.98
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
IP
|
$3.69
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1711480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| 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 |
$3.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.71
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.55
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.31
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
OP
|
$5.07
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1711480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$3.04
|
| Rate for Payer: BCBS Transplant Transplant |
$2.21
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$3.55
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$3.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Galaxy Health WC |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.84
|
| Rate for Payer: IEHP medi-cal |
$0.80
|
| Rate for Payer: IEHP medi-cal |
$0.80
|
| Rate for Payer: IEHP medi-cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.31
|
| Rate for Payer: Riverside University Health MISP |
$2.03
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
OP
|
$8.40
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1712179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: BCBS Transplant Transplant |
$3.17
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$4.22
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Riverside University Health MISP |
$2.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
IP
|
$8.40
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
1712179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| 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: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$4.22
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Networks By Design Commercial |
$2.64
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
OP
|
$13.59
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
NDG28844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.11
|
| Rate for Payer: BCBS Transplant Transplant |
$3.40
|
| Rate for Payer: BCBS Transplant Transplant |
$8.15
|
| Rate for Payer: BCBS Transplant Transplant |
$5.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.28
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$10.87
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$7.59
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Global Benefits Group Commercial |
$8.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.19
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: IEHP medi-cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$7.12
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Multiplan Commercial |
$10.19
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.55
|
| Rate for Payer: Riverside University Health MISP |
$5.44
|
| Rate for Payer: Riverside University Health MISP |
$2.26
|
| Rate for Payer: Riverside University Health MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$4.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$4.74
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
IP
|
$5.66
|
|
|
Service Code
|
CPT J7502
|
| Hospital Charge Code |
NDG28844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| 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 |
$4.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Blue Shield of California Commercial |
$10.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$10.87
|
| Rate for Payer: Central Health Plan Commercial |
$7.59
|
| Rate for Payer: Cigna of CA HMO |
$9.51
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$9.51
|
| Rate for Payer: Cigna of CA PPO |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.07
|
| Rate for Payer: Galaxy Health WC |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$5.69
|
| Rate for Payer: Global Benefits Group Commercial |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Multiplan Commercial |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$7.12
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.55
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.07
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
IP
|
$1.32
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1712180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| 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 |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
OP
|
$1.32
|
|
|
Service Code
|
CPT J7515
|
| Hospital Charge Code |
1712180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$0.92
|
| Rate for Payer: Cigna of CA PPO |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.99
|
| Rate for Payer: IEHP medi-cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$1.12
|
| Rate for Payer: Riverside University Health MISP |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
IP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-15
|
| Hospital Charge Code |
1710485
|
|
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 |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
IP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-11
|
| Hospital Charge Code |
1710485
|
|
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 |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
OP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-11
|
| Hospital Charge Code |
1710485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Central Health Plan Commercial |
$0.62
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: IEHP medi-cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: Riverside University Health MISP |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
