|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
IP
|
$21.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Adventist Health Commercial |
$4.09
|
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.18
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.97
|
| Rate for Payer: Heritage Provider Network Senior |
$9.97
|
| Rate for Payer: Heritage Provider Network Senior |
$9.47
|
| Rate for Payer: Heritage Provider Network Senior |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Multiplan Commercial |
$16.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.13
|
|
|
ATROPINE 1 % EYE DROPS [736]
|
Facility
|
OP
|
$20.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Adventist Health Commercial |
$4.09
|
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Adventist Health Commercial |
$4.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.25
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.16
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California Commercial |
$13.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.14
|
| Rate for Payer: Blue Shield of California EPN |
$9.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$10.65
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.10
|
| Rate for Payer: Heritage Provider Network Senior |
$9.97
|
| Rate for Payer: Heritage Provider Network Senior |
$9.47
|
| Rate for Payer: Heritage Provider Network Senior |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Multiplan Commercial |
$16.16
|
| Rate for Payer: Multiplan Commercial |
$16.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.73
|
| Rate for Payer: TriValley Medical Group Senior |
$8.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.55
|
| Rate for Payer: Vantage Medical Group Senior |
$17.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.31
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$91,754.91
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$68,473.81 |
| Max. Negotiated Rate |
$91,754.91 |
| Rate for Payer: EPIC Health Plan Medicare |
$68,473.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,473.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,744.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91,754.91
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$84,117.11
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$62,773.96 |
| Max. Negotiated Rate |
$84,117.11 |
| Rate for Payer: EPIC Health Plan Medicare |
$62,773.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,773.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72,190.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84,117.11
|
|
|
AVACINCAPTAD PEGOL (PF) 2 MG/0.1 ML INTRAVITREAL SOLUTION [239150]
|
Facility
|
OP
|
$25,200.00
|
|
|
Service Code
|
HCPCS J2782
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$18,900.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,573.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.54
|
| Rate for Payer: Blue Shield of California Commercial |
$107.10
|
| Rate for Payer: Blue Shield of California EPN |
$107.10
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,592.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,128.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$103.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,667.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,667.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,020.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,561.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.29
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,080.00
|
| Rate for Payer: TriValley Medical Group Senior |
$10,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,104.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,343.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.52
|
| Rate for Payer: Vantage Medical Group Senior |
$113.52
|
|
|
AVACINCAPTAD PEGOL (PF) 2 MG/0.1 ML INTRAVITREAL SOLUTION [239150]
|
Facility
|
IP
|
$25,200.00
|
|
|
Service Code
|
HCPCS J2782
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,561.20 |
| Max. Negotiated Rate |
$18,900.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,228.80
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,592.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,608.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,667.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,667.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,300.00
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,104.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,343.72
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION [232506]
|
Facility
|
OP
|
$2,431.75
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.67 |
| Max. Negotiated Rate |
$1,823.81 |
| Rate for Payer: Adventist Health Commercial |
$486.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,502.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.24
|
| Rate for Payer: Blue Shield of California Commercial |
$75.67
|
| Rate for Payer: Blue Shield of California EPN |
$75.67
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,118.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$83.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,125.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,125.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,159.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.49
|
| Rate for Payer: Multiplan Commercial |
$1,823.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$972.70
|
| Rate for Payer: TriValley Medical Group Senior |
$972.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$878.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$805.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.34
|
| Rate for Payer: Vantage Medical Group Senior |
$92.34
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION [232506]
|
Facility
|
IP
|
$2,431.75
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.15 |
| Max. Negotiated Rate |
$1,823.81 |
| Rate for Payer: Adventist Health Commercial |
$486.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,566.05
|
| Rate for Payer: Cash Price |
$1,094.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,118.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,313.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,125.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,125.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.94
|
| Rate for Payer: Multiplan Commercial |
$1,823.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$878.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$805.15
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206411030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$310.15 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,058.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,045.25
|
| Rate for Payer: Blue Shield of California EPN |
$836.20
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,113.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,060.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,060.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$817.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$685.41
|
| Rate for Payer: TriValley Medical Group Senior |
$685.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$856.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 100 MG TABLET [226931]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206411030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$310.15 |
| Max. Negotiated Rate |
$1,285.14 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,103.51
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$925.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,160.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,160.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.38
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206412030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$310.15 |
| Max. Negotiated Rate |
$1,285.14 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,103.51
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$925.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,160.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,160.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.38
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
|
|
AVAPRITINIB 200 MG TABLET [226932]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206412030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$310.15 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,058.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,045.25
|
| Rate for Payer: Blue Shield of California EPN |
$836.20
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,113.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,060.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,060.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$817.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$685.41
|
| Rate for Payer: TriValley Medical Group Senior |
$685.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$856.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
|
OP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206413030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$310.15 |
| Max. Negotiated Rate |
$1,456.49 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,058.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$942.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,285.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,045.25
|
| Rate for Payer: Blue Shield of California EPN |
$836.20
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,113.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,456.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,456.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,060.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,060.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$817.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,199.46
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$685.41
|
| Rate for Payer: TriValley Medical Group Senior |
$685.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$856.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$856.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,456.49
|
| Rate for Payer: Vantage Medical Group Senior |
$1,456.49
|
|
|
AVAPRITINIB 300 MG TABLET [226933]
|
Facility
|
IP
|
$1,713.52
|
|
|
Service Code
|
NDC 7206413030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$310.15 |
| Max. Negotiated Rate |
$1,285.14 |
| Rate for Payer: Adventist Health Commercial |
$342.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,103.51
|
| Rate for Payer: Cash Price |
$771.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$925.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,160.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,160.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$310.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.38
|
| Rate for Payer: Multiplan Commercial |
$1,285.14
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
OP
|
$258.82
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.85 |
| Max. Negotiated Rate |
$194.12 |
| Rate for Payer: Adventist Health Commercial |
$51.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.09
|
| 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 |
$116.47
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$108.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.83
|
| Rate for Payer: Heritage Provider Network Senior |
$119.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$108.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.58
|
| Rate for Payer: Multiplan Commercial |
$194.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$103.53
|
| Rate for Payer: TriValley Medical Group Senior |
$103.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.50
|
| Rate for Payer: Vantage Medical Group Senior |
$119.50
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION [216945]
|
Facility
|
IP
|
$258.82
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.85 |
| Max. Negotiated Rate |
$194.12 |
| Rate for Payer: Adventist Health Commercial |
$51.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.68
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.83
|
| Rate for Payer: Heritage Provider Network Senior |
$119.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.70
|
| Rate for Payer: Multiplan Commercial |
$194.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.70
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Senior |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
AXATILIMAB-CSFR 50 MG/ML INTRAVENOUS SOLUTION [244149]
|
Facility
|
OP
|
$31,980.00
|
|
|
Service Code
|
HCPCS J9038
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$23,985.00 |
| Rate for Payer: Adventist Health Commercial |
$6,396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,763.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.06
|
| Rate for Payer: Blue Shield of California Commercial |
$19,507.80
|
| Rate for Payer: Blue Shield of California EPN |
$15,606.24
|
| Rate for Payer: Cash Price |
$14,391.00
|
| Rate for Payer: Cash Price |
$14,391.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,710.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,467.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$56.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,806.74
|
| Rate for Payer: Heritage Provider Network Senior |
$14,806.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15,254.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,788.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,995.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$23,985.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12,792.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12,792.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,554.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,588.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.11
|
| Rate for Payer: Vantage Medical Group Senior |
$56.46
|
|
|
AXATILIMAB-CSFR 50 MG/ML INTRAVENOUS SOLUTION [244149]
|
Facility
|
IP
|
$31,980.00
|
|
|
Service Code
|
HCPCS J9038
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,788.38 |
| Max. Negotiated Rate |
$23,985.00 |
| Rate for Payer: Adventist Health Commercial |
$6,396.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,595.12
|
| Rate for Payer: Cash Price |
$14,391.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,710.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,269.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,806.74
|
| Rate for Payer: Heritage Provider Network Senior |
$14,806.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,788.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,995.00
|
| Rate for Payer: Multiplan Commercial |
$23,985.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,554.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,588.58
|
|
|
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
|
Facility
|
OP
|
$14,773.56
|
|
|
Service Code
|
CPT 38740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$14,773.56 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,775.56
|
| Rate for Payer: Heritage Provider Network Senior |
$9,563.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,773.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,941.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,553.12
|
| Rate for Payer: TriValley Medical Group Senior |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
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 |
$1.02 |
| Max. Negotiated Rate |
$596.95 |
| Rate for Payer: Adventist Health Commercial |
$140.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.02
|
| 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 |
$9.11
|
| 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 |
$316.03
|
| Rate for Payer: Cash Price |
$316.03
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$334.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 (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: Aetna of CA Non-Gatekeeper |
$452.27
|
| Rate for Payer: Cash Price |
$316.03
|
| 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 Foundation Hospitals 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 (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 |
$1.02 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.11
|
| 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 |
$24.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
AZACITIDINE 100 MG (25 MG/ML) SUBCUTANEOUS INJECTION [408000276]
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| 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 |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
|
|
AZACITIDINE 100 MG INJECTION [78420]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.65
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.00
|
| Rate for Payer: Heritage Provider Network Senior |
$25.00
|
| Rate for Payer: Heritage Provider Network Senior |
$88.90
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
|
