|
BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 51700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$321.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
|
IP
|
$60.55
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$54.49 |
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Blue Shield of California Commercial |
$48.56
|
| Rate for Payer: Blue Shield of California Commercial |
$31.87
|
| Rate for Payer: Blue Shield of California EPN |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$30.52
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Central Health Plan Commercial |
$48.44
|
| Rate for Payer: Central Health Plan Commercial |
$31.79
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: EPIC Health Plan Senior |
$24.22
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$45.41
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Networks By Design Commercial |
$30.27
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Other HMO |
$22.12
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare HMO Rider |
$14.20
|
| Rate for Payer: United Healthcare HMO Rider |
$21.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.83
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [9289]
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$668.80 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Adventist Health Commercial |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$668.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$668.80
|
| Rate for Payer: Blue Shield of California Commercial |
$51.76
|
| Rate for Payer: Blue Shield of California Commercial |
$51.76
|
| Rate for Payer: Blue Shield of California EPN |
$47.05
|
| Rate for Payer: Blue Shield of California EPN |
$47.05
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$27.25
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Central Health Plan Commercial |
$31.79
|
| Rate for Payer: Central Health Plan Commercial |
$48.44
|
| Rate for Payer: Cigna of CA HMO |
$27.82
|
| Rate for Payer: Cigna of CA HMO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$42.38
|
| Rate for Payer: Cigna of CA PPO |
$27.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: EPIC Health Plan Senior |
$24.22
|
| Rate for Payer: Galaxy Health WC |
$51.47
|
| Rate for Payer: Galaxy Health WC |
$33.78
|
| Rate for Payer: Global Benefits Group Commercial |
$23.84
|
| Rate for Payer: Global Benefits Group Commercial |
$36.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$45.41
|
| Rate for Payer: Multiplan Commercial |
$29.80
|
| Rate for Payer: Networks By Design Commercial |
$30.27
|
| Rate for Payer: Networks By Design Commercial |
$19.87
|
| Rate for Payer: Prime Health Services Commercial |
$33.78
|
| Rate for Payer: Prime Health Services Commercial |
$51.47
|
| Rate for Payer: Riverside University Health System MISP |
$24.22
|
| Rate for Payer: Riverside University Health System MISP |
$15.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Other HMO |
$22.12
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare HMO Rider |
$14.20
|
| Rate for Payer: United Healthcare HMO Rider |
$21.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.47
|
| Rate for Payer: Vantage Medical Group Senior |
$51.47
|
| Rate for Payer: Vantage Medical Group Senior |
$33.78
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
|
IP
|
$80.03
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$72.03 |
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Adventist Health Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California Commercial |
$64.18
|
| Rate for Payer: Blue Shield of California Commercial |
$90.10
|
| Rate for Payer: Blue Shield of California EPN |
$56.62
|
| Rate for Payer: Blue Shield of California EPN |
$40.34
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Central Health Plan Commercial |
$64.02
|
| Rate for Payer: Central Health Plan Commercial |
$89.87
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$44.94
|
| Rate for Payer: EPIC Health Plan Senior |
$32.01
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.04
|
| Rate for Payer: United Healthcare All Other HMO |
$29.23
|
| Rate for Payer: United Healthcare All Other HMO |
$41.04
|
| Rate for Payer: United Healthcare HMO Rider |
$40.15
|
| Rate for Payer: United Healthcare HMO Rider |
$28.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.21
|
|
|
BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION [17012]
|
Facility
|
OP
|
$112.34
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$668.80 |
| Rate for Payer: Adventist Health Commercial |
$22.47
|
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$668.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$668.80
|
| Rate for Payer: Blue Shield of California Commercial |
$51.76
|
| Rate for Payer: Blue Shield of California Commercial |
$51.76
|
| Rate for Payer: Blue Shield of California EPN |
$47.05
|
| Rate for Payer: Blue Shield of California EPN |
$47.05
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$36.01
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Central Health Plan Commercial |
$89.87
|
| Rate for Payer: Central Health Plan Commercial |
$64.02
|
| Rate for Payer: Cigna of CA HMO |
$78.64
|
| Rate for Payer: Cigna of CA HMO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$56.02
|
| Rate for Payer: Cigna of CA PPO |
$78.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$44.94
|
| Rate for Payer: EPIC Health Plan Senior |
$32.01
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Galaxy Health WC |
$95.49
|
| Rate for Payer: Global Benefits Group Commercial |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.02
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Multiplan Commercial |
$84.25
|
| Rate for Payer: Networks By Design Commercial |
$40.02
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Prime Health Services Commercial |
$95.49
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Riverside University Health System MISP |
$32.01
|
| Rate for Payer: Riverside University Health System MISP |
$44.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.04
|
| Rate for Payer: United Healthcare All Other HMO |
$29.23
|
| Rate for Payer: United Healthcare All Other HMO |
$41.04
|
| Rate for Payer: United Healthcare HMO Rider |
$40.15
|
| Rate for Payer: United Healthcare HMO Rider |
$28.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
| Rate for Payer: Vantage Medical Group Senior |
$95.49
|
|
|
BLEPHAROPLASTY, UPPER EYELID;
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 15822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| 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 |
$3,703.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$580.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT [208374]
|
Facility
|
IP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,413.64 |
| Max. Negotiated Rate |
$6,361.40 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5,668.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.38
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,654.58
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,827.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2,827.29
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,361.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,170.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.64
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT [208374]
|
Facility
|
OP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$6,361.40 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.31
|
| Rate for Payer: Blue Shield of California Commercial |
$194.05
|
| Rate for Payer: Blue Shield of California EPN |
$176.41
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,654.58
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.29
|
| Rate for Payer: EPIC Health Plan Senior |
$190.19
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,361.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: Prime Health Services Medicare |
$183.27
|
| Rate for Payer: Riverside University Health System MISP |
$190.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,240.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,240.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Vantage Medical Group Senior |
$190.19
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT FOR HOME INFUSION DOCUMENTATION ORDER [4082180]
|
Facility
|
OP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$6,361.40 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.31
|
| Rate for Payer: Blue Shield of California Commercial |
$194.05
|
| Rate for Payer: Blue Shield of California EPN |
$176.41
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,654.58
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.29
|
| Rate for Payer: EPIC Health Plan Senior |
$190.19
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,361.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: Prime Health Services Medicare |
$183.27
|
| Rate for Payer: Riverside University Health System MISP |
$190.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,240.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,240.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$172.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Vantage Medical Group Senior |
$190.19
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT FOR HOME INFUSION DOCUMENTATION ORDER [4082180]
|
Facility
|
IP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,413.64 |
| Max. Negotiated Rate |
$6,361.40 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5,668.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.38
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,654.58
|
| Rate for Payer: Cigna of CA HMO |
$4,947.75
|
| Rate for Payer: Cigna of CA PPO |
$4,947.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,947.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,827.29
|
| Rate for Payer: EPIC Health Plan Senior |
$2,827.29
|
| Rate for Payer: Galaxy Health WC |
$6,007.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4,240.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,361.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,488.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,170.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.64
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: Networks By Design Commercial |
$3,534.11
|
| Rate for Payer: Prime Health Services Commercial |
$6,007.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,652.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,582.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2,526.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,314.84
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$34,117.32
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$34,117.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,117.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,038.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,854.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,987.38
|
| Rate for Payer: EPIC Health Plan Senior |
$20,658.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,780.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,292.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,165.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,780.23
|
| Rate for Payer: Prime Health Services Medicare |
$19,907.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$21,847.40
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,847.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,847.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,112.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,758.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,378.11
|
| Rate for Payer: EPIC Health Plan Senior |
$13,585.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,350.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,290.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,549.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,350.37
|
| Rate for Payer: Prime Health Services Medicare |
$13,091.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Riverside University Health System MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.75
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Senior |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.80
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.61
|
| Rate for Payer: Prime Health Services Commercial |
$0.80
|
| Rate for Payer: Riverside University Health System MISP |
$0.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO |
$0.47
|
| Rate for Payer: United Healthcare HMO Rider |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,635.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,346.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Riverside University Health System MISP |
$769.44
|
| Rate for Payer: Riverside University Health System MISP |
$96.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.16
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| 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 |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$702.69
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,542.73
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$120.96
|
| Rate for Payer: Blue Shield of California EPN |
$969.49
|
| Rate for Payer: Blue Shield of California EPN |
$25.40
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare All Other HMO |
$702.69
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.17
|
| Rate for Payer: Blue Shield of California Commercial |
$60.46
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Medicare |
$7.39
|
| Rate for Payer: Riverside University Health System MISP |
$7.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Other HMO |
$702.68
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
IP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,542.71
|
| Rate for Payer: Blue Shield of California EPN |
$969.48
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Senior |
$769.43
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Other HMO |
$702.68
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.97
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
OP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$1,731.24 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,635.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,346.52
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: Riverside University Health System MISP |
$769.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.93
|
| Rate for Payer: United Healthcare All Other HMO |
$702.69
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.17
|
| Rate for Payer: Blue Shield of California Commercial |
$60.46
|
| Rate for Payer: Blue Shield of California EPN |
$54.96
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: Prime Health Services Medicare |
$7.39
|
| Rate for Payer: Riverside University Health System MISP |
$7.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,154.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Other HMO |
$702.68
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
IP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.24 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,542.73
|
| Rate for Payer: Blue Shield of California EPN |
$969.49
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.88
|
| Rate for Payer: Cigna of CA HMO |
$1,346.52
|
| Rate for Payer: Cigna of CA PPO |
$1,346.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.44
|
| Rate for Payer: EPIC Health Plan Senior |
$769.44
|
| Rate for Payer: Galaxy Health WC |
$1,635.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Networks By Design Commercial |
$961.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.93
|
| Rate for Payer: United Healthcare All Other HMO |
$702.69
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.98
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
IP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$1,731.22 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,542.71
|
| Rate for Payer: Blue Shield of California EPN |
$969.48
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Central Health Plan Commercial |
$1,538.86
|
| Rate for Payer: Cigna of CA HMO |
$1,346.51
|
| Rate for Payer: Cigna of CA PPO |
$1,346.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,346.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.43
|
| Rate for Payer: EPIC Health Plan Senior |
$769.43
|
| Rate for Payer: Galaxy Health WC |
$1,635.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,731.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,221.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,134.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: Networks By Design Commercial |
$961.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Other HMO |
$702.68
|
| Rate for Payer: United Healthcare HMO Rider |
$687.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.97
|
|
