|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
|
|
ATROPINE 1 % EYE DROPS < 2 ML (PROCEDURAL) [408736]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
NDC 0065-0817-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$12.33 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.85
|
| Rate for Payer: Blue Shield of California EPN |
$7.08
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Senior |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.80
|
| Rate for Payer: TriValley Medical Group Senior |
$5.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
IP
|
$21.82
|
|
|
Service Code
|
NDC 60505-6226-0
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.77
|
| Rate for Payer: Heritage Provider Network Senior |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
OP
|
$21.82
|
|
|
Service Code
|
NDC 60505-6226-0
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.31
|
| Rate for Payer: Blue Shield of California EPN |
$10.65
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.55
|
| Rate for Payer: Dignity Health Senior |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.51
|
| Rate for Payer: Heritage Provider Network Senior |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.27
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.73
|
| Rate for Payer: TriValley Medical Group Senior |
$8.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.55
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
OP
|
$251.28
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$260.74 |
| Rate for Payer: Adventist Health Commercial |
$50.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$172.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.74
|
| Rate for Payer: Blue Shield of California Commercial |
$98.74
|
| Rate for Payer: Blue Shield of California EPN |
$98.74
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.33
|
| Rate for Payer: Dignity Health Senior |
$110.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$100.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.34
|
| Rate for Payer: Heritage Provider Network Senior |
$116.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$100.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.38
|
| Rate for Payer: Multiplan Commercial |
$188.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.51
|
| Rate for Payer: TriValley Medical Group Senior |
$100.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.33
|
| Rate for Payer: Vantage Medical Group Senior |
$110.33
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
IP
|
$251.28
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$188.46 |
| Rate for Payer: Adventist Health Commercial |
$50.26
|
| Rate for Payer: Cash Price |
$138.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.34
|
| Rate for Payer: Heritage Provider Network Senior |
$116.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.82
|
| Rate for Payer: Multiplan Commercial |
$188.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.20
|
|
|
AZACITIDINE 100 MG (10 MG/ML) INTRAVENOUS INJECTION [40878420]
|
Facility
|
IP
|
$702.29
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$526.72 |
| Rate for Payer: Adventist Health Commercial |
$140.46
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.16
|
| Rate for Payer: Heritage Provider Network Senior |
$325.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.57
|
| Rate for Payer: Multiplan Commercial |
$526.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$232.53
|
|
|
AZACITIDINE 100 MG (10 MG/ML) INTRAVENOUS INJECTION [40878420]
|
Facility
|
OP
|
$702.29
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$596.95 |
| Rate for Payer: Adventist Health Commercial |
$140.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$375.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Cash Price |
$386.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.95
|
| Rate for Payer: Dignity Health Senior |
$596.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.16
|
| Rate for Payer: Heritage Provider Network Senior |
$325.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$334.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$491.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$491.60
|
| Rate for Payer: Multiplan Commercial |
$526.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$280.92
|
| Rate for Payer: TriValley Medical Group Senior |
$280.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.95
|
| Rate for Payer: Vantage Medical Group Senior |
$596.95
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.53
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Senior |
$84.00
|
| Rate for Payer: TriValley Medical Group Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.12
|
| Rate for Payer: Heritage Provider Network Senior |
$111.12
|
| Rate for Payer: Heritage Provider Network Senior |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.46
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Senior |
$45.90
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.12
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Heritage Provider Network Senior |
$97.23
|
| Rate for Payer: Heritage Provider Network Senior |
$111.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Senior |
$84.00
|
| Rate for Payer: TriValley Medical Group Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
|
|
AZATHIOPRINE 25 MG 1/2 TAB [4081407]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
|
|
AZATHIOPRINE 50 MG TABLET [9183]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.16
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
|
|
AZATHIOPRINE ORAL SUSPENSION COMPOUND 50 MG/ML [4080245]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.69
|
| Rate for Payer: Dignity Health Senior |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Vantage Medical Group Senior |
$0.69
|
|
|
AZELASTINE 0.05 % EYE DROPS [28351]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 61314-308-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.42
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.95
|
| Rate for Payer: Dignity Health Senior |
$5.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5.95
|
|
|
AZELASTINE 0.05 % EYE DROPS [28351]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 61314-308-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 59651-214-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Senior |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 47335-779-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Senior |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 60505-0833-5
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Senior |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 60505-0833-5
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.74
|
| Rate for Payer: Dignity Health Senior |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
|
AZELASTINE 137 MCG (0.1 %) NASAL SPRAY [19179]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 47335-779-91
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.74
|
| Rate for Payer: Dignity Health Senior |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Senior |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.74
|
| Rate for Payer: Vantage Medical Group Senior |
$0.74
|
|
