|
CYCLOPHOSPHAMIDE ORAL SUSPENSION COMPOUND 10 MG/ML [4080261]
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
NDC 9994-0802-61
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.59
|
| Rate for Payer: Heritage Provider Network Senior |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
|
OP
|
$140.86
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$119.73 |
| Rate for Payer: Adventist Health Commercial |
$28.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.64
|
| Rate for Payer: Blue Shield of California Commercial |
$85.92
|
| Rate for Payer: Blue Shield of California EPN |
$68.74
|
| Rate for Payer: Cash Price |
$77.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.73
|
| Rate for Payer: Dignity Health Senior |
$119.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.19
|
| Rate for Payer: Heritage Provider Network Senior |
$87.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$105.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.34
|
| Rate for Payer: TriValley Medical Group Senior |
$56.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.73
|
| Rate for Payer: Vantage Medical Group Senior |
$119.73
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS [216389]
|
Facility
|
IP
|
$140.86
|
|
|
Service Code
|
NDC 0023-5301-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$105.64 |
| Rate for Payer: Adventist Health Commercial |
$28.17
|
| Rate for Payer: Cash Price |
$77.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.36
|
| Rate for Payer: Heritage Provider Network Senior |
$95.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.22
|
| Rate for Payer: Multiplan Commercial |
$105.64
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 73043-005-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
NDC 73043-005-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Adventist Health Commercial |
$0.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.26
|
| Rate for Payer: Dignity Health Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$2.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.53
|
| Rate for Payer: TriValley Medical Group Senior |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.26
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$3.22
|
|
|
Service Code
|
NDC 68180-214-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.74
|
| Rate for Payer: Dignity Health Senior |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.29
|
| Rate for Payer: TriValley Medical Group Senior |
$1.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Vantage Medical Group Senior |
$2.74
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 68180-214-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: Dignity Health Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
NDC 60505-6202-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
OP
|
$21.91
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.65
|
| Rate for Payer: Dignity Health Senior |
$18.65
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: Dignity Health Senior |
$18.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$7.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.87
|
| Rate for Payer: Multiplan Commercial |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$16.43
|
| Rate for Payer: Multiplan Commercial |
$16.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.78
|
| Rate for Payer: TriValley Medical Group Senior |
$6.78
|
| Rate for Payer: TriValley Medical Group Senior |
$8.78
|
| Rate for Payer: TriValley Medical Group Senior |
$8.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.65
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$18.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.62
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
IP
|
$21.91
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.49
|
| Rate for Payer: Multiplan Commercial |
$16.45
|
| Rate for Payer: Multiplan Commercial |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.25
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
OP
|
$17.09
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$180.71 |
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.71
|
| Rate for Payer: Blue Shield of California Commercial |
$69.78
|
| Rate for Payer: Blue Shield of California Commercial |
$69.78
|
| Rate for Payer: Blue Shield of California EPN |
$69.78
|
| Rate for Payer: Blue Shield of California EPN |
$69.78
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.53
|
| Rate for Payer: Dignity Health Senior |
$14.52
|
| Rate for Payer: Dignity Health Senior |
$14.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.96
|
| Rate for Payer: Multiplan Commercial |
$12.82
|
| Rate for Payer: Multiplan Commercial |
$12.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.83
|
| Rate for Payer: TriValley Medical Group Senior |
$6.83
|
| Rate for Payer: TriValley Medical Group Senior |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.52
|
| Rate for Payer: Vantage Medical Group Senior |
$14.53
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
IP
|
$17.08
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$12.81 |
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Adventist Health Commercial |
$3.42
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$12.82
|
| Rate for Payer: Multiplan Commercial |
$12.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.66
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Adventist Health Commercial |
$1.11
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.73
|
| Rate for Payer: Dignity Health Senior |
$4.73
|
| Rate for Payer: Dignity Health Senior |
$4.89
|
| Rate for Payer: Dignity Health Senior |
$4.67
|
| Rate for Payer: Dignity Health Senior |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.03
|
| Rate for Payer: Multiplan Commercial |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Multiplan Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2.30
|
| Rate for Payer: TriValley Medical Group Senior |
$2.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.89
|
| Rate for Payer: Vantage Medical Group Senior |
$3.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.67
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.89
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
IP
|
$5.56
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Adventist Health Commercial |
$1.11
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.41
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.49
|
| Rate for Payer: Dignity Health Senior |
$7.49
|
| Rate for Payer: Dignity Health Senior |
$2.55
|
| Rate for Payer: Dignity Health Senior |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3.52
|
| Rate for Payer: TriValley Medical Group Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
CYCLOSPORINE MODIFIED 100 MG CAPSULE [28843]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.75
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2.62
|
| Rate for Payer: Heritage Provider Network Senior |
$7.12
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.99
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: Dignity Health Senior |
$8.47
|
| Rate for Payer: Dignity Health Senior |
$13.07
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.77
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$7.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.15
|
| Rate for Payer: TriValley Medical Group Senior |
$6.15
|
| Rate for Payer: TriValley Medical Group Senior |
$3.98
|
| Rate for Payer: TriValley Medical Group Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE [28842]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Senior |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Senior |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 50268-189-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Senior |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Senior |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 50742-190-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Senior |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
