|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206412030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,542.17 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.24
|
| Rate for Payer: Blue Shield of California EPN |
$863.61
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,370.82
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.70
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206412030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,542.17 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,040.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$829.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.37
|
| Rate for Payer: Blue Shield of California EPN |
$683.69
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,370.82
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
| Rate for Payer: Riverside University Health System MISP |
$685.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,028.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.76
|
| Rate for Payer: United Healthcare All Other HMO |
$856.76
|
| Rate for Payer: United Healthcare HMO Rider |
$856.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206413030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,542.17 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,040.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$829.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.37
|
| Rate for Payer: Blue Shield of California EPN |
$683.69
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,370.82
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
| Rate for Payer: Riverside University Health System MISP |
$685.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,028.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$856.76
|
| Rate for Payer: United Healthcare All Other HMO |
$856.76
|
| Rate for Payer: United Healthcare HMO Rider |
$856.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206413030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$1,542.17 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,374.24
|
| Rate for Payer: Blue Shield of California EPN |
$863.61
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Central Health Plan Commercial |
$1,370.82
|
| Rate for Payer: Cigna of CA HMO |
$1,199.46
|
| Rate for Payer: Cigna of CA PPO |
$1,199.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,199.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.41
|
| Rate for Payer: EPIC Health Plan Senior |
$685.41
|
| Rate for Payer: Galaxy Health WC |
$1,456.49
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,542.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,088.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,010.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.70
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: Networks By Design Commercial |
$1,113.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.49
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
OP
|
$258.82
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$232.94 |
| Rate for Payer: Adventist Health Commercial |
$51.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$108.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.57
|
| Rate for Payer: Blue Shield of California Commercial |
$127.78
|
| Rate for Payer: Blue Shield of California EPN |
$116.16
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Central Health Plan Commercial |
$207.06
|
| Rate for Payer: Cigna of CA HMO |
$181.17
|
| Rate for Payer: Cigna of CA PPO |
$181.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$181.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.26
|
| Rate for Payer: EPIC Health Plan Senior |
$119.50
|
| Rate for Payer: Galaxy Health WC |
$220.00
|
| Rate for Payer: Global Benefits Group Commercial |
$155.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$178.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$108.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.58
|
| Rate for Payer: Multiplan Commercial |
$194.12
|
| Rate for Payer: Networks By Design Commercial |
$129.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$108.64
|
| Rate for Payer: Prime Health Services Commercial |
$220.00
|
| Rate for Payer: Prime Health Services Medicare |
$115.16
|
| Rate for Payer: Riverside University Health System MISP |
$119.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.14
|
| Rate for Payer: United Healthcare All Other HMO |
$94.55
|
| Rate for Payer: United Healthcare HMO Rider |
$92.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$108.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.50
|
| Rate for Payer: Vantage Medical Group Senior |
$119.50
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
IP
|
$258.82
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$232.94 |
| Rate for Payer: Adventist Health Commercial |
$51.76
|
| Rate for Payer: Blue Shield of California Commercial |
$207.57
|
| Rate for Payer: Blue Shield of California EPN |
$130.45
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Central Health Plan Commercial |
$207.06
|
| Rate for Payer: Cigna of CA HMO |
$181.17
|
| Rate for Payer: Cigna of CA PPO |
$181.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$181.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.53
|
| Rate for Payer: EPIC Health Plan Senior |
$103.53
|
| Rate for Payer: Galaxy Health WC |
$220.00
|
| Rate for Payer: Global Benefits Group Commercial |
$155.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.76
|
| Rate for Payer: Multiplan Commercial |
$194.12
|
| Rate for Payer: Networks By Design Commercial |
$129.41
|
| Rate for Payer: Prime Health Services Commercial |
$220.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.14
|
| Rate for Payer: United Healthcare All Other HMO |
$94.55
|
| Rate for Payer: United Healthcare HMO Rider |
$92.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.76
|
|
|
AXATILIMAB-CSFR 50 MG/ML INTRAVENOUS SOLUTION [244149]
|
Facility
|
OP
|
$31,980.00
|
|
|
Service Code
|
HCPCS J9038
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$28,782.00 |
| Rate for Payer: Adventist Health Commercial |
$6,396.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$56.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.05
|
| Rate for Payer: Blue Shield of California Commercial |
$20,275.32
|
| Rate for Payer: Blue Shield of California EPN |
$12,760.02
|
| Rate for Payer: Cash Price |
$14,391.00
|
| Rate for Payer: Cash Price |
$14,391.00
|
| Rate for Payer: Central Health Plan Commercial |
$25,584.00
|
| Rate for Payer: Cigna of CA HMO |
$22,386.00
|
| Rate for Payer: Cigna of CA PPO |
$22,386.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,386.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.16
|
| Rate for Payer: EPIC Health Plan Senior |
$62.11
|
| Rate for Payer: Galaxy Health WC |
$27,183.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,782.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$92.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,307.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$23,985.00
|
| Rate for Payer: Networks By Design Commercial |
$15,990.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$56.46
|
| Rate for Payer: Prime Health Services Commercial |
$27,183.00
|
| Rate for Payer: Prime Health Services Medicare |
$59.85
|
| Rate for Payer: Riverside University Health System MISP |
$62.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,188.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19,188.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,002.09
|
| Rate for Payer: United Healthcare All Other HMO |
$11,682.29
|
| Rate for Payer: United Healthcare HMO Rider |
$11,429.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,473.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$56.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.11
|
| Rate for Payer: Vantage Medical Group Senior |
$56.46
|
|
|
AXATILIMAB-CSFR 50 MG/ML INTRAVENOUS SOLUTION [244149]
|
Facility
|
IP
|
$31,980.00
|
|
|
Service Code
|
HCPCS J9038
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,396.00 |
| Max. Negotiated Rate |
$28,782.00 |
| Rate for Payer: Adventist Health Commercial |
$6,396.00
|
| Rate for Payer: Blue Shield of California Commercial |
$25,647.96
|
| Rate for Payer: Blue Shield of California EPN |
$16,117.92
|
| Rate for Payer: Cash Price |
$14,391.00
|
| Rate for Payer: Central Health Plan Commercial |
$25,584.00
|
| Rate for Payer: Cigna of CA HMO |
$22,386.00
|
| Rate for Payer: Cigna of CA PPO |
$22,386.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,386.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,792.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,792.00
|
| Rate for Payer: Galaxy Health WC |
$27,183.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,782.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,307.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,868.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,396.00
|
| Rate for Payer: Multiplan Commercial |
$23,985.00
|
| Rate for Payer: Networks By Design Commercial |
$15,990.00
|
| Rate for Payer: Prime Health Services Commercial |
$27,183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,002.09
|
| Rate for Payer: United Healthcare All Other HMO |
$11,682.29
|
| Rate for Payer: United Healthcare HMO Rider |
$11,429.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,473.45
|
|
|
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 38740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,775.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Medicare |
$8,242.09
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
AZACITIDINE 100 MG (10 MG/ML) INTRAVENOUS INJECTION [40878420]
|
Facility
|
OP
|
$702.29
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$632.06 |
| Rate for Payer: Adventist Health Commercial |
$140.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| 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: Dignity Health Medi-Cal |
$596.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.92
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$491.60
|
| 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 System 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 |
$263.57
|
| Rate for Payer: United Healthcare All Other HMO |
$256.55
|
| Rate for Payer: United Healthcare HMO Rider |
$251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.95
|
| Rate for Payer: Vantage Medical Group Senior |
$596.95
|
|
|
AZACITIDINE 100 MG (10 MG/ML) INTRAVENOUS INJECTION [40878420]
|
Facility
|
IP
|
$702.29
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$632.06 |
| Rate for Payer: Adventist Health Commercial |
$140.46
|
| Rate for Payer: Blue Shield of California Commercial |
$563.24
|
| Rate for Payer: Blue Shield of California EPN |
$353.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.92
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$445.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.35
|
| 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: United Healthcare All Other Commercial |
$263.57
|
| Rate for Payer: United Healthcare All Other HMO |
$256.55
|
| Rate for Payer: United Healthcare HMO Rider |
$251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| 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 |
$9.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California Commercial |
$43.31
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| 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 Exchange |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Riverside University Health System MISP |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California Commercial |
$43.31
|
| Rate for Payer: Blue Shield of California Commercial |
$153.98
|
| Rate for Payer: Blue Shield of California EPN |
$96.77
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$153.60
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$248.76 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| 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 |
$248.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| 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 |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| 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 |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$248.76 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| 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 |
$248.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| 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: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$248.76 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| 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: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.57
|
| 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 System 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 |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZELASTINE 0.05 % EYE DROPS [28351]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 6131430802
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$3.53
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Central Health Plan Commercial |
$5.60
|
| Rate for Payer: Cigna of CA HMO |
$4.90
|
| Rate for Payer: Cigna of CA PPO |
$4.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
|
|
AZELASTINE 0.05 % EYE DROPS [28351]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 6131430802
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4.44
|
| Rate for Payer: Blue Shield of California EPN |
$2.79
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Central Health Plan Commercial |
$5.60
|
| Rate for Payer: Cigna of CA HMO |
$4.90
|
| Rate for Payer: Cigna of CA PPO |
$4.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
| Rate for Payer: Riverside University Health System MISP |
$2.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5.95
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 4733577991
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 4733577991
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.61
|
| Rate for Payer: Cigna of CA PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.74
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.74
|
| Rate for Payer: Riverside University Health System MISP |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
