|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
OP
|
$9.95
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.46
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: Dignity Health Senior |
$11.91
|
| Rate for Payer: Dignity Health Senior |
$8.46
|
| Rate for Payer: Dignity Health Senior |
$11.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.49
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.91
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$11.48
|
|
|
OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]
|
Facility
IP
|
$13.50
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.14
|
| Rate for Payer: Heritage Provider Network Senior |
$6.74
|
| Rate for Payer: Heritage Provider Network Senior |
$9.18
|
| Rate for Payer: Heritage Provider Network Senior |
$9.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$7.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.51
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
IP
|
$28.03
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Adventist Health Commercial |
$3.98
|
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.26
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.98
|
| Rate for Payer: Heritage Provider Network Senior |
$18.98
|
| Rate for Payer: Heritage Provider Network Senior |
$13.47
|
| Rate for Payer: Heritage Provider Network Senior |
$18.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.06
|
|
|
OXACILLIN 2 GRAM SOLUTION FOR INJECTION [5926]
|
Facility
OP
|
$27.12
|
|
|
Service Code
|
CPT J2700
|
| Hospital Charge Code |
1753547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Adventist Health Commercial |
$3.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.05
|
| Rate for Payer: Dignity Health Senior |
$16.92
|
| Rate for Payer: Dignity Health Senior |
$23.05
|
| Rate for Payer: Dignity Health Senior |
$23.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.21
|
| Rate for Payer: Heritage Provider Network Senior |
$12.56
|
| Rate for Payer: Heritage Provider Network Senior |
$9.21
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: IEHP Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$23.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.92
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
1755749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION [99612]
|
Facility
OP
|
$2.40
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
1755749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$1.68
|
| Rate for Payer: Dignity Health Senior |
$1.02
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
OP
|
$636.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$477.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.60
|
| Rate for Payer: Dignity Health Senior |
$540.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.47
|
| Rate for Payer: Heritage Provider Network Senior |
$294.47
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$306.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$212.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
|
|
OXALIPLATIN 100 MG INTRAVENOUS SOLUTION [23929]
|
Facility
IP
|
$636.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.93
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.57
|
| Rate for Payer: Heritage Provider Network Senior |
$430.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$212.49
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
NDG99610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [99610]
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
NDG99610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$218.47
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.29
|
| Rate for Payer: Heritage Provider Network Senior |
$215.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.24
|
|
|
OXALIPLATIN 50 MG INTRAVENOUS SOLUTION [23928]
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT J9263
|
| Hospital Charge Code |
ERX23928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$218.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$238.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: Dignity Health Senior |
$270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.23
|
| Rate for Payer: IEHP Medi-Cal |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$153.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
OXANDROLONE 10 MG TABLET [33826]
|
Facility
IP
|
$11.30
|
|
|
Service Code
|
NDC 0245-0272-06
|
| Hospital Charge Code |
1710982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.76
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.65
|
| Rate for Payer: Heritage Provider Network Senior |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.48
|
|
|
OXANDROLONE 10 MG TABLET [33826]
|
Facility
OP
|
$11.30
|
|
|
Service Code
|
NDC 0245-0272-06
|
| Hospital Charge Code |
1710982
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.48
|
| Rate for Payer: Blue Shield of California Commercial |
$7.02
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.60
|
| Rate for Payer: Dignity Health Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9.60
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
OP
|
$5.19
|
|
|
Service Code
|
NDC 49884-301-01
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.05
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.41
|
| Rate for Payer: Dignity Health Senior |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Senior |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Vantage Medical Group Senior |
$4.41
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
OP
|
$3.33
|
|
|
Service Code
|
NDC 0245-0271-11
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.07
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.83
|
| Rate for Payer: Dignity Health Senior |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2.83
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 49884-301-01
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.57
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.51
|
| Rate for Payer: Heritage Provider Network Senior |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
|
|
OXANDROLONE 2.5 MG TABLET [10803]
|
Facility
IP
|
$3.33
|
|
|
Service Code
|
NDC 0245-0271-11
|
| Hospital Charge Code |
1710935
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.29
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
OP
|
$0.36
|
|
|
Service Code
|
NDC 62756-183-88
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
OP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-11
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
IP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-11
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 68462-137-01
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
IP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-01
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 62756-183-88
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
|
|
OXCARBAZEPINE 150 MG TABLET [27049]
|
Facility
OP
|
$0.65
|
|
|
Service Code
|
NDC 68084-845-01
|
| Hospital Charge Code |
1710905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.55
|
| Rate for Payer: Dignity Health Senior |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Vantage Medical Group Senior |
$0.55
|
|
