|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$56,854.18
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$47,709.80 |
| Max. Negotiated Rate |
$56,854.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$47,709.80
|
| Rate for Payer: IEHP medi-cal |
$56,854.18
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$47,568.25
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$39,917.41 |
| Max. Negotiated Rate |
$47,568.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,917.41
|
| Rate for Payer: IEHP medi-cal |
$47,568.25
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$90,289.97
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$75,767.81 |
| Max. Negotiated Rate |
$90,289.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$75,767.81
|
| Rate for Payer: IEHP medi-cal |
$90,289.97
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
IP
|
$35,744.92
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$29,995.74 |
| Max. Negotiated Rate |
$35,744.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,995.74
|
| Rate for Payer: IEHP medi-cal |
$35,744.92
|
|
|
Autologous chondrocyte implantation, knee
|
Facility
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 27412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,114.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| 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 |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: IEHP medi-cal |
$14,748.57
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Innovage PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
IP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-110-30
|
| Hospital Charge Code |
ERX226931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,267.67 |
| Rate for Payer: Blue Shield of California Commercial |
$1,056.39
|
| Rate for Payer: Blue Shield of California EPN |
$752.15
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,126.82
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,267.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.70
|
| Rate for Payer: Multiplan Commercial |
$1,056.39
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
OP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-110-30
|
| Hospital Charge Code |
ERX226931
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,267.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$855.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,197.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$774.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$774.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.15
|
| Rate for Payer: BCBS Transplant Transplant |
$845.11
|
| Rate for Payer: Blue Shield of California Commercial |
$885.96
|
| Rate for Payer: Blue Shield of California EPN |
$688.77
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,126.82
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,197.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,267.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,056.39
|
| Rate for Payer: IEHP medi-cal |
$492.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.70
|
| Rate for Payer: Multiplan Commercial |
$1,056.39
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: Riverside University Health MISP |
$563.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.26
|
| Rate for Payer: United Healthcare All Other HMO |
$704.26
|
| Rate for Payer: United Healthcare HMO Rider |
$704.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,197.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,197.24
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
OP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-120-30
|
| Hospital Charge Code |
ERX226932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,267.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$855.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,197.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$774.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$774.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.15
|
| Rate for Payer: BCBS Transplant Transplant |
$845.11
|
| Rate for Payer: Blue Shield of California Commercial |
$885.96
|
| Rate for Payer: Blue Shield of California EPN |
$688.77
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,126.82
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,197.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,267.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,056.39
|
| Rate for Payer: IEHP medi-cal |
$492.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.70
|
| Rate for Payer: Multiplan Commercial |
$1,056.39
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: Riverside University Health MISP |
$563.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.26
|
| Rate for Payer: United Healthcare All Other HMO |
$704.26
|
| Rate for Payer: United Healthcare HMO Rider |
$704.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,197.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,197.24
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
IP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-120-30
|
| Hospital Charge Code |
ERX226932
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,267.67 |
| Rate for Payer: Blue Shield of California Commercial |
$1,056.39
|
| Rate for Payer: Blue Shield of California EPN |
$752.15
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,126.82
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,267.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.70
|
| Rate for Payer: Multiplan Commercial |
$1,056.39
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
IP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-130-30
|
| Hospital Charge Code |
ERX226933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,267.67 |
| Rate for Payer: Blue Shield of California Commercial |
$1,056.39
|
| Rate for Payer: Blue Shield of California EPN |
$752.15
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,126.82
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,267.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.70
|
| Rate for Payer: Multiplan Commercial |
$1,056.39
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
OP
|
$1,408.52
|
|
|
Service Code
|
NDC 72064-130-30
|
| Hospital Charge Code |
ERX226933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$1,267.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$855.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,197.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$774.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$774.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.15
|
| Rate for Payer: BCBS Transplant Transplant |
$845.11
|
| Rate for Payer: Blue Shield of California Commercial |
$885.96
|
| Rate for Payer: Blue Shield of California EPN |
$688.77
|
| Rate for Payer: Cash Price |
$633.83
|
| Rate for Payer: Central Health Plan Commercial |
$1,126.82
|
| Rate for Payer: Cigna of CA HMO |
$985.96
|
| Rate for Payer: Cigna of CA PPO |
$985.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,197.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$563.41
|
| Rate for Payer: Galaxy Health WC |
$1,197.24
|
| Rate for Payer: Global Benefits Group Commercial |
$845.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,267.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,056.39
|
| Rate for Payer: IEHP medi-cal |
$492.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.70
|
| Rate for Payer: Multiplan Commercial |
$1,056.39
|
| Rate for Payer: Networks By Design Commercial |
$915.54
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: Riverside University Health MISP |
$563.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.26
|
| Rate for Payer: United Healthcare All Other HMO |
$704.26
|
| Rate for Payer: United Healthcare HMO Rider |
$704.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,197.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,197.24
|
|
|
AZACITIDINE 100 MG (10 MG/ML) INTRAVENOUS INJECTION [40878420]
|
Facility
IP
|
$702.29
|
|
|
Service Code
|
CPT J9025
|
| Hospital Charge Code |
ERX40878420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$632.06 |
| Rate for Payer: Blue Shield of California Commercial |
$526.72
|
| Rate for Payer: Blue Shield of California EPN |
$375.02
|
| Rate for Payer: Cash Price |
$316.03
|
| Rate for Payer: Central Health Plan Commercial |
$561.83
|
| Rate for Payer: Cigna of CA HMO |
$491.60
|
| Rate for Payer: Cigna of CA PPO |
$491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.92
|
| Rate for Payer: Galaxy Health WC |
$596.95
|
| Rate for Payer: Global Benefits Group Commercial |
$421.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.46
|
| Rate for Payer: Multiplan Commercial |
$526.72
|
| Rate for Payer: Networks By Design Commercial |
$351.14
|
| Rate for Payer: Prime Health Services Commercial |
$596.95
|
|
|
AZACITIDINE 100 MG (10 MG/ML) INTRAVENOUS INJECTION [40878420]
|
Facility
OP
|
$702.29
|
|
|
Service Code
|
CPT J9025
|
| Hospital Charge Code |
ERX40878420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$632.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$596.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$386.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$386.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: BCBS Transplant Transplant |
$421.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$316.03
|
| Rate for Payer: Cash Price |
$316.03
|
| Rate for Payer: Central Health Plan Commercial |
$561.83
|
| Rate for Payer: Cigna of CA HMO |
$491.60
|
| Rate for Payer: Cigna of CA PPO |
$491.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.92
|
| Rate for Payer: Galaxy Health WC |
$596.95
|
| Rate for Payer: Global Benefits Group Commercial |
$421.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$526.72
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.46
|
| Rate for Payer: Multiplan Commercial |
$526.72
|
| Rate for Payer: Networks By Design Commercial |
$351.14
|
| Rate for Payer: Prime Health Services Commercial |
$596.95
|
| Rate for Payer: Riverside University Health MISP |
$280.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.14
|
| Rate for Payer: United Healthcare All Other HMO |
$351.14
|
| Rate for Payer: United Healthcare HMO Rider |
$351.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.95
|
| Rate for Payer: Vantage Medical Group Senior |
$596.95
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT J9025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Blue Shield of California Commercial |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$57.67
|
| Rate for Payer: Blue Shield of California EPN |
$115.34
|
| Rate for Payer: Blue Shield of California EPN |
$112.14
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$108.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT J9025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$118.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: BCBS Transplant Transplant |
$126.00
|
| Rate for Payer: BCBS Transplant Transplant |
$64.80
|
| Rate for Payer: BCBS Transplant Transplant |
$129.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Central Health Plan Commercial |
$86.40
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$75.60
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$151.20
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$75.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$81.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$157.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$162.00
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health MISP |
$86.40
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Riverside University Health MISP |
$43.20
|
| Rate for Payer: Riverside University Health MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$108.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$108.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT J9025
|
| Hospital Charge Code |
1755716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.15
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: BCBS Transplant Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$157.50
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Riverside University Health MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT J9025
|
| Hospital Charge Code |
1755716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Blue Shield of California Commercial |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$112.14
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
IP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDC4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
OP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDC4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
OP
|
$0.66
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
ERX4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
ERX4081407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
IP
|
$0.41
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
1710262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
OP
|
$0.41
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
1710262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
OP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDG4080245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.61
|
| Rate for Payer: IEHP medi-cal |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO |
$0.41
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
IP
|
$0.81
|
|
|
Service Code
|
CPT J7500
|
| Hospital Charge Code |
NDG4080245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
|
