|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT [208374]
|
Facility
|
OP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.95 |
| Max. Negotiated Rate |
$5,301.16 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,368.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.97
|
| Rate for Payer: Blue Shield of California Commercial |
$149.95
|
| Rate for Payer: Blue Shield of California EPN |
$149.95
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,251.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,523.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$172.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,272.59
|
| Rate for Payer: Heritage Provider Network Senior |
$3,272.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,371.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,279.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,827.29
|
| Rate for Payer: TriValley Medical Group Senior |
$2,827.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,553.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,340.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Vantage Medical Group Senior |
$190.19
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT [208374]
|
Facility
|
IP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,279.35 |
| Max. Negotiated Rate |
$5,301.16 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,551.93
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,251.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,816.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,272.59
|
| Rate for Payer: Heritage Provider Network Senior |
$3,272.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,279.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.06
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,553.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,340.29
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT FOR HOME INFUSION DOCUMENTATION ORDER [4082180]
|
Facility
|
OP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.95 |
| Max. Negotiated Rate |
$5,301.16 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,368.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.97
|
| Rate for Payer: Blue Shield of California Commercial |
$149.95
|
| Rate for Payer: Blue Shield of California EPN |
$149.95
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,251.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,523.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$172.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,272.59
|
| Rate for Payer: Heritage Provider Network Senior |
$3,272.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,371.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,279.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,827.29
|
| Rate for Payer: TriValley Medical Group Senior |
$2,827.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,553.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,340.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.19
|
| Rate for Payer: Vantage Medical Group Senior |
$190.19
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT FOR HOME INFUSION DOCUMENTATION ORDER [4082180]
|
Facility
|
IP
|
$7,068.22
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,279.35 |
| Max. Negotiated Rate |
$5,301.16 |
| Rate for Payer: Adventist Health Commercial |
$1,413.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,551.93
|
| Rate for Payer: Cash Price |
$3,180.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,251.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,816.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,272.59
|
| Rate for Payer: Heritage Provider Network Senior |
$3,272.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,279.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.06
|
| Rate for Payer: Multiplan Commercial |
$5,301.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,553.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,340.29
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$20,606.90
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$15,378.28 |
| Max. Negotiated Rate |
$20,606.90 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,378.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,378.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,685.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,606.90
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$13,448.19
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$10,035.96 |
| Max. Negotiated Rate |
$13,448.19 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,035.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,035.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,541.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,448.19
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
BONE MARROW HARVESTING FOR TRANSPLANTATION; AUTOLOGOUS
|
Facility
|
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 38232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,601.90
|
| 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 |
$8,402.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,601.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,890.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,643.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,442.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,506.55
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,162.09
|
| Rate for Payer: TriValley Medical Group Senior |
$6,162.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5,601.90
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900648
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.61
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Senior |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Vantage Medical Group Senior |
$0.80
|
|
|
BORIC ACID (BULK) POWDER [1131]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 3877900649
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.61
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.71
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,238.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$890.63
|
| Rate for Payer: Heritage Provider Network Senior |
$111.12
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.90
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
|
|
BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION [35839]
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$69.13 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,635.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.63
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$111.12
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$890.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$917.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,346.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$769.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Senior |
$769.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
IP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$1,442.68 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,238.79
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.62
|
| Rate for Payer: Heritage Provider Network Senior |
$890.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.89
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
|
|
BORTEZOMIB 3.5 MG INTRAVENOUS POWDER FOR SOLUTION [220799]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$1,442.68 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.09
|
| Rate for Payer: Blue Shield of California Commercial |
$46.72
|
| Rate for Payer: Blue Shield of California EPN |
$46.72
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.62
|
| Rate for Payer: Heritage Provider Network Senior |
$890.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$917.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$769.43
|
| Rate for Payer: TriValley Medical Group Senior |
$769.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
IP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,238.80
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.63
|
| Rate for Payer: Heritage Provider Network Senior |
$890.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.90
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
OP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$1,442.68 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.09
|
| Rate for Payer: Blue Shield of California Commercial |
$46.72
|
| Rate for Payer: Blue Shield of California EPN |
$46.72
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.62
|
| Rate for Payer: Heritage Provider Network Senior |
$890.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$917.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.34
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$769.43
|
| Rate for Payer: TriValley Medical Group Senior |
$769.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
OP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$1,635.06 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,635.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.63
|
| Rate for Payer: Heritage Provider Network Senior |
$890.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$917.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,346.52
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$769.44
|
| Rate for Payer: TriValley Medical Group Senior |
$769.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG IV INJECTION. [408035839]
|
Facility
|
IP
|
$1,923.58
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$1,442.68 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,238.79
|
| Rate for Payer: Cash Price |
$865.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.62
|
| Rate for Payer: Heritage Provider Network Senior |
$890.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.89
|
| Rate for Payer: Multiplan Commercial |
$1,442.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
|
|
BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION SQ [40835839]
|
Facility
|
OP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$1,635.06 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,057.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,442.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,635.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.63
|
| Rate for Payer: Heritage Provider Network Senior |
$890.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$917.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,346.52
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$769.44
|
| Rate for Payer: TriValley Medical Group Senior |
$769.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1,635.06
|
|
|
BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION SQ [40835839]
|
Facility
|
IP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$348.17 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$384.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,238.80
|
| Rate for Payer: Cash Price |
$865.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$884.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.63
|
| Rate for Payer: Heritage Provider Network Senior |
$890.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.90
|
| Rate for Payer: Multiplan Commercial |
$1,442.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$636.90
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
NDC 6838244714
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$13.09 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.24
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.81
|
| Rate for Payer: Heritage Provider Network Senior |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
|
|
BOSENTAN 125 MG TABLET [31876]
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
NDC 6838244714
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.64
|
| Rate for Payer: Blue Shield of California EPN |
$8.52
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Senior |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.83
|
|
