|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 7304300501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE [35209]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 7304300501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.76
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.80
|
| Rate for Payer: Heritage Provider Network Senior |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
OP
|
$16.95
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| 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 |
$10.06
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.36
|
| Rate for Payer: Heritage Provider Network Senior |
$10.35
|
| Rate for Payer: Heritage Provider Network Senior |
$7.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$16.76
|
| Rate for Payer: Multiplan Commercial |
$16.79
|
| Rate for Payer: Multiplan Commercial |
$12.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.95
|
| Rate for Payer: TriValley Medical Group Senior |
$8.95
|
| Rate for Payer: TriValley Medical Group Senior |
$8.94
|
| Rate for Payer: TriValley Medical Group Senior |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$19.02
|
| Rate for Payer: Vantage Medical Group Senior |
$19.00
|
|
|
CYCLOSPORINE 100 MG CAPSULE [9706]
|
Facility
|
IP
|
$22.38
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$16.79 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.92
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.35
|
| Rate for Payer: Heritage Provider Network Senior |
$10.35
|
| Rate for Payer: Heritage Provider Network Senior |
$7.85
|
| Rate for Payer: Heritage Provider Network Senior |
$10.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$16.79
|
| Rate for Payer: Multiplan Commercial |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$16.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.40
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
IP
|
$17.42
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.22
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$13.06
|
| Rate for Payer: Multiplan Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.77
|
|
|
CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION [9705]
|
Facility
|
OP
|
$17.42
|
|
|
Service Code
|
HCPCS J7516
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.52
|
| 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 |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.19
|
| Rate for Payer: Multiplan Commercial |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$13.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.97
|
| Rate for Payer: TriValley Medical Group Senior |
$6.97
|
| Rate for Payer: TriValley Medical Group Senior |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.82
|
| Rate for Payer: Vantage Medical Group Senior |
$14.82
|
| Rate for Payer: Vantage Medical Group Senior |
$14.81
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
HCPCS J7515
|
| 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 |
$1.12
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.59
|
| 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 |
$2.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.66
|
| 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 |
$1.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| 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+ |
$1.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.90
|
|
|
CYCLOSPORINE 25 MG CAPSULE [9707]
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.12
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Adventist Health Commercial |
$0.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$2.59
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.89
|
| 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 |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.03
|
| Rate for Payer: Multiplan Commercial |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.30
|
| Rate for Payer: TriValley Medical Group Senior |
$2.26
|
| Rate for Payer: TriValley Medical Group Senior |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.89
|
| Rate for Payer: Vantage Medical Group Senior |
$3.61
|
|
|
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 |
$0.74
|
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.96
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.29
|
| 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 |
$1.71
|
| Rate for Payer: Heritage Provider Network Senior |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.07
|
|
|
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 |
$11.31 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| 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 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: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.70
|
| 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 |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1.71
|
| Rate for Payer: Heritage Provider Network Senior |
$4.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Senior |
$1.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.11
|
| Rate for Payer: TriValley Medical Group Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
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 |
$2.09
|
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.74
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.26
|
| Rate for Payer: Heritage Provider Network Senior |
$7.26
|
| Rate for Payer: Heritage Provider Network Senior |
$4.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: Multiplan Commercial |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.19
|
|
|
CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION [28844]
|
Facility
|
OP
|
$10.46
|
|
|
Service Code
|
HCPCS J7502
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.31
|
| 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 |
$7.06
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.62
|
| Rate for Payer: Heritage Provider Network Senior |
$7.26
|
| Rate for Payer: Heritage Provider Network Senior |
$4.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.98
|
| Rate for Payer: Multiplan Commercial |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2.26
|
| Rate for Payer: TriValley Medical Group Senior |
$6.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$13.34
|
|
|
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 |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| 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 |
$2.67
|
| 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 |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
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: Aetna of CA Non-Gatekeeper |
$0.85
|
| Rate for Payer: Cash Price |
$0.59
|
| 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 Foundation Hospitals 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
|
|
|
CYPROHEPTADINE 4 MG TABLET [2033]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 5026818915
|
| 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 Non-Gatekeeper |
$0.48
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| 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 |
$0.35
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 5026818915
|
| 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: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| 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 Foundation Hospitals 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 5026818911
|
| 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 Non-Gatekeeper |
$0.48
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| 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 |
$0.35
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 5026818911
|
| 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: Aetna of CA Non-Gatekeeper |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| 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 Foundation Hospitals 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
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 5074219001
|
| 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: Aetna of CA Non-Gatekeeper |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| 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 Foundation Hospitals 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
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 5074219001
|
| 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 Non-Gatekeeper |
$0.04
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| 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 |
$0.03
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Adventist Health Commercial |
$2.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.00
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$9.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.12
|
|
|
CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION [4294]
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Adventist Health Commercial |
$2.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.70
|
| Rate for Payer: Multiplan Commercial |
$9.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.57
|
| Rate for Payer: Vantage Medical Group Senior |
$10.57
|
|
|
CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,688.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| 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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Senior |
$3,306.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,108.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,957.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2,957.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; LARGE BLADDER TUMOR(S)
|
Facility
|
OP
|
$13,102.72
|
|
|
Service Code
|
CPT 52240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$13,102.72 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| 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 |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,896.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8,482.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,102.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,930.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,585.79
|
| Rate for Payer: TriValley Medical Group Senior |
$7,585.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,533.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| 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 |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
