|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-08
|
| Hospital Charge Code |
NDG10000B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-31
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-01
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.77
|
| Rate for Payer: BCBS Transplant Transplant |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.24
|
| Rate for Payer: IEHP medi-cal |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: Riverside University Health MISP |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.25
|
|
|
Service Code
|
NDC 68001-265-25
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.80
|
| Rate for Payer: Cigna of CA HMO |
$1.58
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.69
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Riverside University Health MISP |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.35
|
| 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 |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
OP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$150.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.91
|
| Rate for Payer: BCBS Transplant Transplant |
$54.24
|
| Rate for Payer: Blue Shield of California Commercial |
$99.44
|
| Rate for Payer: Blue Shield of California EPN |
$90.40
|
| Rate for Payer: Caremore Medicare Advantage |
$76.61
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Central Health Plan Commercial |
$72.32
|
| Rate for Payer: Cigna of CA HMO |
$63.28
|
| Rate for Payer: Cigna of CA PPO |
$63.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.61
|
| Rate for Payer: Galaxy Health WC |
$76.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.64
|
| Rate for Payer: IEHP medi-cal |
$126.41
|
| Rate for Payer: IEHP Medicare Advantage |
$76.61
|
| Rate for Payer: Innovage PACE Commercial |
$114.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.66
|
| Rate for Payer: Multiplan Commercial |
$67.80
|
| Rate for Payer: Networks By Design Commercial |
$45.20
|
| Rate for Payer: Prime Health Services Commercial |
$76.84
|
| Rate for Payer: Prime Health Services Medicare |
$81.21
|
| Rate for Payer: Riverside University Health MISP |
$84.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.20
|
| Rate for Payer: United Healthcare All Other HMO |
$45.20
|
| Rate for Payer: United Healthcare HMO Rider |
$45.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: Vantage Medical Group Senior |
$76.61
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
IP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Blue Shield of California Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.27
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Central Health Plan Commercial |
$72.32
|
| Rate for Payer: Cigna of CA HMO |
$63.28
|
| Rate for Payer: Cigna of CA PPO |
$63.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.16
|
| Rate for Payer: Galaxy Health WC |
$76.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$67.80
|
| Rate for Payer: Networks By Design Commercial |
$45.20
|
| Rate for Payer: Prime Health Services Commercial |
$76.84
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
IP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Blue Shield of California Commercial |
$11.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.84
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.75
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Networks By Design Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
OP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.68
|
| Rate for Payer: BCBS Transplant Transplant |
$8.81
|
| Rate for Payer: Blue Shield of California Commercial |
$9.24
|
| Rate for Payer: Blue Shield of California EPN |
$7.18
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.75
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.02
|
| Rate for Payer: IEHP medi-cal |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Networks By Design Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: Riverside University Health MISP |
$5.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Vantage Medical Group Senior |
$12.49
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
IP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Blue Shield of California Commercial |
$22.03
|
| Rate for Payer: Blue Shield of California EPN |
$15.68
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Central Health Plan Commercial |
$23.50
|
| Rate for Payer: Cigna of CA HMO |
$20.56
|
| Rate for Payer: Cigna of CA PPO |
$20.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.75
|
| Rate for Payer: Galaxy Health WC |
$24.96
|
| Rate for Payer: Global Benefits Group Commercial |
$17.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$22.03
|
| Rate for Payer: Networks By Design Commercial |
$19.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.96
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
OP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$26.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.35
|
| Rate for Payer: BCBS Transplant Transplant |
$17.62
|
| Rate for Payer: Blue Shield of California Commercial |
$18.47
|
| Rate for Payer: Blue Shield of California EPN |
$14.36
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Central Health Plan Commercial |
$23.50
|
| Rate for Payer: Cigna of CA HMO |
$20.56
|
| Rate for Payer: Cigna of CA PPO |
$20.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.75
|
| Rate for Payer: Galaxy Health WC |
$24.96
|
| Rate for Payer: Global Benefits Group Commercial |
$17.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.03
|
| Rate for Payer: IEHP medi-cal |
$10.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$22.03
|
| Rate for Payer: Networks By Design Commercial |
$19.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.62
|
| Rate for Payer: Riverside University Health MISP |
$11.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.68
|
| Rate for Payer: United Healthcare All Other HMO |
$14.68
|
| Rate for Payer: United Healthcare HMO Rider |
$14.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.96
|
| Rate for Payer: Vantage Medical Group Senior |
$24.96
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: BCBS Transplant Transplant |
$21.90
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Central Health Plan Commercial |
$29.20
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.38
|
| Rate for Payer: IEHP medi-cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Riverside University Health MISP |
$14.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
IP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Blue Shield of California Commercial |
$27.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.49
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Central Health Plan Commercial |
$29.20
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
IP
|
$12.16
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Blue Shield of California Commercial |
$9.12
|
| Rate for Payer: Blue Shield of California EPN |
$6.49
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Central Health Plan Commercial |
$9.73
|
| Rate for Payer: Cigna of CA HMO |
$8.51
|
| Rate for Payer: Cigna of CA PPO |
$8.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
OP
|
$12.16
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712485
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$17.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: BCBS Transplant Transplant |
$7.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7.65
|
| Rate for Payer: Blue Shield of California EPN |
$5.95
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: Central Health Plan Commercial |
$9.73
|
| Rate for Payer: Cigna of CA HMO |
$8.51
|
| Rate for Payer: Cigna of CA PPO |
$8.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.86
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.12
|
| Rate for Payer: IEHP medi-cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$9.12
|
| Rate for Payer: Networks By Design Commercial |
$7.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.30
|
| Rate for Payer: Riverside University Health MISP |
$4.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.08
|
| Rate for Payer: United Healthcare All Other HMO |
$6.08
|
| Rate for Payer: United Healthcare HMO Rider |
$6.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.34
|
| Rate for Payer: Vantage Medical Group Senior |
$10.34
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
OP
|
$24.36
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$21.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: BCBS Transplant Transplant |
$14.62
|
| Rate for Payer: BCBS Transplant Transplant |
$11.42
|
| Rate for Payer: BCBS Transplant Transplant |
$14.59
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Central Health Plan Commercial |
$19.49
|
| Rate for Payer: Central Health Plan Commercial |
$19.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Cigna of CA HMO |
$17.02
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA HMO |
$17.05
|
| Rate for Payer: Cigna of CA PPO |
$17.05
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$20.71
|
| Rate for Payer: Galaxy Health WC |
$20.66
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Global Benefits Group Commercial |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$14.59
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.27
|
| Rate for Payer: IEHP medi-cal |
$2.20
|
| Rate for Payer: IEHP medi-cal |
$2.20
|
| Rate for Payer: IEHP medi-cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$18.23
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$18.27
|
| Rate for Payer: Networks By Design Commercial |
$12.16
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Prime Health Services Commercial |
$20.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.71
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
| Rate for Payer: Riverside University Health MISP |
$9.74
|
| Rate for Payer: Riverside University Health MISP |
$7.61
|
| Rate for Payer: Riverside University Health MISP |
$9.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.52
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.16
|
| Rate for Payer: United Healthcare All Other HMO |
$9.52
|
| Rate for Payer: United Healthcare HMO Rider |
$9.52
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.66
|
| Rate for Payer: Vantage Medical Group Senior |
$20.66
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$20.71
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
IP
|
$19.03
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$17.13 |
| Rate for Payer: Blue Shield of California Commercial |
$14.27
|
| Rate for Payer: Blue Shield of California Commercial |
$18.27
|
| Rate for Payer: Blue Shield of California Commercial |
$18.23
|
| Rate for Payer: Blue Shield of California EPN |
$13.01
|
| Rate for Payer: Blue Shield of California EPN |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.16
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: Central Health Plan Commercial |
$15.22
|
| Rate for Payer: Central Health Plan Commercial |
$19.45
|
| Rate for Payer: Central Health Plan Commercial |
$19.49
|
| Rate for Payer: Cigna of CA HMO |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$13.32
|
| Rate for Payer: Cigna of CA HMO |
$17.02
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$17.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.18
|
| Rate for Payer: Galaxy Health WC |
$20.66
|
| Rate for Payer: Galaxy Health WC |
$20.71
|
| Rate for Payer: Global Benefits Group Commercial |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.42
|
| Rate for Payer: Global Benefits Group Commercial |
$14.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$18.27
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$18.23
|
| Rate for Payer: Networks By Design Commercial |
$12.18
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$12.16
|
| Rate for Payer: Prime Health Services Commercial |
$20.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.71
|
| Rate for Payer: Prime Health Services Commercial |
$16.18
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.92
|
| Rate for Payer: BCBS Transplant Transplant |
$21.90
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.51
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Central Health Plan Commercial |
$29.20
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.38
|
| Rate for Payer: IEHP medi-cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Riverside University Health MISP |
$14.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
IP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
1712487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Blue Shield of California Commercial |
$27.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.49
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Central Health Plan Commercial |
$29.20
|
| Rate for Payer: Cigna of CA HMO |
$25.55
|
| Rate for Payer: Cigna of CA PPO |
$25.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: Networks By Design Commercial |
$18.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
Evisceration of ocular contents; with implant
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 65093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,830.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,830.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,521.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,830.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,922.50
|
| Rate for Payer: IEHP medi-cal |
$7,970.80
|
| Rate for Payer: IEHP Medicare Advantage |
$4,830.79
|
| Rate for Payer: Innovage PACE Commercial |
$7,246.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,830.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,473.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,473.26
|
| Rate for Payer: Prime Health Services Medicare |
$5,120.64
|
| Rate for Payer: Riverside University Health MISP |
$5,313.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
Exchange of intraocular lens
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 66986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,911.63 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$4,804.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67966
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 67961
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,919.67 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: IEHP medi-cal |
$4,817.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Innovage PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health MISP |
$3,211.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
Excision aural glomus tumor; transmastoid
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,603.71 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
