|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: InnovAge PACE Commercial |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: Riverside University Health System MISP |
$5.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.25
|
| Rate for Payer: United Healthcare All Other HMO |
$7.25
|
| Rate for Payer: United Healthcare HMO Rider |
$7.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.31
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
OP
|
$21.82
|
|
|
Service Code
|
NDC 60505-6226-0
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$13.33
|
| Rate for Payer: Blue Shield of California EPN |
$8.71
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.46
|
| Rate for Payer: Cigna of CA HMO |
$13.96
|
| Rate for Payer: Cigna of CA PPO |
$16.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$8.73
|
| Rate for Payer: Galaxy Health WC |
$18.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.64
|
| Rate for Payer: InnovAge PACE Commercial |
$10.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: Networks By Design Commercial |
$14.18
|
| Rate for Payer: Prime Health Services Commercial |
$18.55
|
| Rate for Payer: Riverside University Health System MISP |
$8.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.91
|
| Rate for Payer: United Healthcare All Other HMO |
$10.91
|
| Rate for Payer: United Healthcare HMO Rider |
$10.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.55
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
IP
|
$21.82
|
|
|
Service Code
|
NDC 60505-6226-0
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California Commercial |
$16.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$8.73
|
| Rate for Payer: Galaxy Health WC |
$18.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: Networks By Design Commercial |
$14.18
|
| Rate for Payer: Prime Health Services Commercial |
$18.55
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
OP
|
$251.28
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$226.15 |
| Rate for Payer: Adventist Health Commercial |
$50.26
|
| Rate for Payer: Adventist Health Medi-Cal |
$100.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.94
|
| 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 |
$138.21
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Central Health Plan Commercial |
$201.02
|
| Rate for Payer: Cigna of CA HMO |
$175.90
|
| Rate for Payer: Cigna of CA PPO |
$175.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.30
|
| Rate for Payer: Galaxy Health WC |
$213.59
|
| Rate for Payer: Global Benefits Group Commercial |
$150.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$164.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$100.30
|
| Rate for Payer: InnovAge PACE Commercial |
$150.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$188.46
|
| Rate for Payer: Networks By Design Commercial |
$125.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$100.30
|
| Rate for Payer: Prime Health Services Commercial |
$213.59
|
| Rate for Payer: Prime Health Services Medicare |
$106.32
|
| Rate for Payer: Riverside University Health System MISP |
$110.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.31
|
| Rate for Payer: United Healthcare All Other HMO |
$91.79
|
| Rate for Payer: United Healthcare HMO Rider |
$89.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$100.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.33
|
| Rate for Payer: Vantage Medical Group Senior |
$110.33
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
IP
|
$251.28
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$226.15 |
| Rate for Payer: Adventist Health Commercial |
$50.26
|
| Rate for Payer: Blue Shield of California Commercial |
$194.24
|
| Rate for Payer: Blue Shield of California EPN |
$126.65
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Central Health Plan Commercial |
$201.02
|
| Rate for Payer: Cigna of CA HMO |
$175.90
|
| Rate for Payer: Cigna of CA PPO |
$175.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.51
|
| Rate for Payer: EPIC Health Plan Senior |
$100.51
|
| Rate for Payer: Galaxy Health WC |
$213.59
|
| Rate for Payer: Global Benefits Group Commercial |
$150.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.26
|
| Rate for Payer: Multiplan Commercial |
$188.46
|
| Rate for Payer: Networks By Design Commercial |
$125.64
|
| Rate for Payer: Prime Health Services Commercial |
$213.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.31
|
| Rate for Payer: United Healthcare All Other HMO |
$91.79
|
| Rate for Payer: United Healthcare HMO Rider |
$89.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.29
|
|
|
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 |
$542.87
|
| Rate for Payer: Blue Shield of California EPN |
$353.95
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Central Health Plan Commercial |
$561.83
|
| Rate for Payer: Cigna of CA HMO |
$491.60
|
| Rate for Payer: Cigna of CA PPO |
$491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.92
|
| Rate for Payer: EPIC Health Plan 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 Permanente of CA Commercial/Self Funded |
$468.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.72
|
| 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 (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 |
$0.32 |
| Max. Negotiated Rate |
$632.06 |
| Rate for Payer: Adventist Health Commercial |
$140.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$426.50
|
| 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 |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| 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 |
$386.26
|
| Rate for Payer: Cash Price |
$386.26
|
| 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: 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 |
$0.32
|
| Rate for Payer: InnovAge PACE Commercial |
$351.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$434.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.60
|
| Rate for Payer: Molina Healthcare of CA 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 (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.74
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| 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 |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| 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 |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| 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 |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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 |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| 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 |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.32
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: InnovAge PACE Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| 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 |
$29.70
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.32
|
| Rate for Payer: InnovAge PACE Commercial |
$27.00
|
| Rate for Payer: InnovAge PACE Commercial |
$120.00
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Riverside University Health System MISP |
$96.00
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare All Other HMO |
$87.67
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.74
|
| Rate for Payer: Blue Shield of California Commercial |
$185.52
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Blue Shield of California EPN |
$120.96
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Central Health Plan Commercial |
$192.00
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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 |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$168.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$96.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$144.00
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$160.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$120.00
|
| Rate for Payer: Prime Health Services Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| 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 |
$76.71
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$85.78
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| 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 |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| 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 |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.21
|
| Rate for Payer: InnovAge PACE Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| 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 |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| 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 Commercial |
$0.15
|
| 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 |
$0.15
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| 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 |
$0.35
|
|
|
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 |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$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 |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| 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 |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| 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 |
$0.15
|
| 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 |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$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 |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| 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 |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| 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 |
$0.15
|
| 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
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| 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 |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.69
|
| 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 |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.21
|
| Rate for Payer: InnovAge PACE Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| 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 |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| 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 Commercial |
$0.15
|
| 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 |
$0.15
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| 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 |
$0.35
|
|
|
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 |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$0.57
|
| Rate for Payer: Cigna of CA PPO |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan 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 Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| 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 |
$0.16 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| 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 |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| 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 |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| 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: 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 |
$1.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA 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 61314-308-02
|
| 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 |
$5.41
|
| Rate for Payer: Blue Shield of California EPN |
$3.53
|
| Rate for Payer: Cash Price |
$3.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| 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 61314-308-02
|
| 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 |
$4.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.79
|
| Rate for Payer: Cash Price |
$3.85
|
| 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: 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: InnovAge PACE Commercial |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 47335-779-91
|
| 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 |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.48
|
| 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: 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: InnovAge PACE Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.61
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 59651-214-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 60505-0833-5
|
| 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 |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.48
|
| 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: 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: InnovAge PACE Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.61
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 47335-779-91
|
| 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 |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.48
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| 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
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 60505-0833-5
|
| 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 |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.48
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| 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
|
|
