|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
OP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$205.31 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$125.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.74
|
| Rate for Payer: Heritage Provider Network Senior |
$126.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$130.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$109.50
|
| Rate for Payer: TriValley Medical Group Senior |
$109.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$90.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.09
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
IP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$205.31 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$176.29
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$125.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.74
|
| Rate for Payer: Heritage Provider Network Senior |
$126.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.44
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$90.64
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$556.68 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$556.68
|
| Rate for Payer: Blue Shield of California Commercial |
$310.61
|
| Rate for Payer: Blue Shield of California EPN |
$310.61
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.66
|
| Rate for Payer: Heritage Provider Network Senior |
$32.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.69
|
| Rate for Payer: Multiplan Commercial |
$52.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.22
|
| Rate for Payer: TriValley Medical Group Senior |
$28.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.48
|
| Rate for Payer: Vantage Medical Group Senior |
$193.48
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.43
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.66
|
| Rate for Payer: Heritage Provider Network Senior |
$32.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$52.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.36
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.00
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5.75
|
| Rate for Payer: Heritage Provider Network Senior |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.28
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.42
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$992.23 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$992.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$992.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$992.23
|
| Rate for Payer: Blue Shield of California Commercial |
$52.77
|
| Rate for Payer: Blue Shield of California Commercial |
$52.77
|
| Rate for Payer: Blue Shield of California Commercial |
$52.77
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5.75
|
| Rate for Payer: Heritage Provider Network Senior |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.06
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.43
|
| Rate for Payer: TriValley Medical Group Senior |
$6.43
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
OP
|
$62.45
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$53.08 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.84
|
| Rate for Payer: Blue Shield of California Commercial |
$38.09
|
| Rate for Payer: Blue Shield of California EPN |
$30.48
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Senior |
$28.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.72
|
| Rate for Payer: Multiplan Commercial |
$46.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.98
|
| Rate for Payer: TriValley Medical Group Senior |
$24.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
IP
|
$62.45
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$46.84 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.22
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Senior |
$28.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$46.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.68
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.42
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.73
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$319.90 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.90
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$319.90 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.90
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.41
|
| Rate for Payer: Heritage Provider Network Senior |
$32.25
|
| Rate for Payer: Heritage Provider Network Senior |
$20.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.86
|
| Rate for Payer: TriValley Medical Group Senior |
$17.64
|
| Rate for Payer: TriValley Medical Group Senior |
$27.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
IP
|
$44.09
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.07 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.39
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.86
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.25
|
| Rate for Payer: Heritage Provider Network Senior |
$32.25
|
| Rate for Payer: Heritage Provider Network Senior |
$20.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.41
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
IP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.36 |
| Max. Negotiated Rate |
$96.79 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.11
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.75
|
| Rate for Payer: Heritage Provider Network Senior |
$59.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.26
|
| Rate for Payer: Multiplan Commercial |
$96.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.73
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION [10249]
|
Facility
|
OP
|
$129.05
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.36 |
| Max. Negotiated Rate |
$319.90 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.90
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cash Price |
$58.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.75
|
| Rate for Payer: Heritage Provider Network Senior |
$59.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$61.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.33
|
| Rate for Payer: Multiplan Commercial |
$96.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.62
|
| Rate for Payer: TriValley Medical Group Senior |
$51.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.69
|
| Rate for Payer: Vantage Medical Group Senior |
$109.69
|
|
|
IMAGE-GUIDED FLUID COLLECTION DRAINAGE BY CATHETER (EG, ABSCESS, HEMATOMA, SEROMA, LYMPHOCELE, CYST); VISCERAL (EG, KIDNEY, LIVER, SPLEEN, LUNG/MEDIASTINUM), PERCUTANEOUS
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 49405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,124.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.41
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2.82
|
| Rate for Payer: Heritage Provider Network Senior |
$0.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$3.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Senior |
$1.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.59
|
| Rate for Payer: TriValley Medical Group Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.25
|
| Rate for Payer: Heritage Provider Network Senior |
$3.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$3.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.08
|
| Rate for Payer: TriValley Medical Group Senior |
$2.08
|
| Rate for Payer: TriValley Medical Group Senior |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.42
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.38
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION [241932]
|
Facility
|
OP
|
$12,772.56
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$9,579.42 |
| Rate for Payer: Adventist Health Commercial |
$2,554.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,893.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.43
|
| Rate for Payer: Blue Shield of California Commercial |
$53.63
|
| Rate for Payer: Blue Shield of California EPN |
$53.63
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,875.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,174.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,913.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,913.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,092.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,311.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.77
|
| Rate for Payer: Multiplan Commercial |
$9,579.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,109.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5,109.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,614.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,228.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Vantage Medical Group Senior |
$65.48
|
|
|
IMETELSTAT 188 MG INTRAVENOUS SOLUTION [241932]
|
Facility
|
IP
|
$12,772.56
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,311.83 |
| Max. Negotiated Rate |
$9,579.42 |
| Rate for Payer: Adventist Health Commercial |
$2,554.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,225.53
|
| Rate for Payer: Cash Price |
$5,747.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,875.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,897.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,913.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,913.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,311.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.14
|
| Rate for Payer: Multiplan Commercial |
$9,579.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,614.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,228.99
|
|
|
IMETELSTAT 47 MG INTRAVENOUS SOLUTION [241930]
|
Facility
|
IP
|
$3,193.14
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$577.96 |
| Max. Negotiated Rate |
$2,394.86 |
| Rate for Payer: Adventist Health Commercial |
$638.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,056.38
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,468.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,724.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,478.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,478.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$577.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.28
|
| Rate for Payer: Multiplan Commercial |
$2,394.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,153.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,057.25
|
|
|
IMETELSTAT 47 MG INTRAVENOUS SOLUTION [241930]
|
Facility
|
OP
|
$3,193.14
|
|
|
Service Code
|
HCPCS J0870
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$2,394.86 |
| Rate for Payer: Adventist Health Commercial |
$638.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,973.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.43
|
| Rate for Payer: Blue Shield of California Commercial |
$53.63
|
| Rate for Payer: Blue Shield of California EPN |
$53.63
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,468.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,043.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,478.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,478.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,523.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$577.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.77
|
| Rate for Payer: Multiplan Commercial |
$2,394.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,277.26
|
| Rate for Payer: TriValley Medical Group Senior |
$1,277.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,153.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,057.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.48
|
| Rate for Payer: Vantage Medical Group Senior |
$65.48
|
|
|
IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION [26431]
|
Facility
|
IP
|
$2,101.76
|
|
|
Service Code
|
HCPCS J1786
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.42 |
| Max. Negotiated Rate |
$1,576.32 |
| Rate for Payer: Adventist Health Commercial |
$420.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,353.53
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$973.11
|
| Rate for Payer: Heritage Provider Network Senior |
$973.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.44
|
| Rate for Payer: Multiplan Commercial |
$1,576.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$759.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$695.89
|
|
|
IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION [26431]
|
Facility
|
OP
|
$2,101.76
|
|
|
Service Code
|
HCPCS J1786
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.33 |
| Max. Negotiated Rate |
$1,576.32 |
| Rate for Payer: Adventist Health Commercial |
$420.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,298.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.16
|
| Rate for Payer: Blue Shield of California Commercial |
$43.78
|
| Rate for Payer: Blue Shield of California EPN |
$43.78
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cash Price |
$945.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,345.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$43.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$973.11
|
| Rate for Payer: Heritage Provider Network Senior |
$973.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,002.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$1,576.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$840.70
|
| Rate for Payer: TriValley Medical Group Senior |
$840.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$759.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$695.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.66
|
| Rate for Payer: Vantage Medical Group Senior |
$47.66
|
|
