|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 67457-902-00
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| 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 |
$0.81
|
| 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 Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
NDC 67457-902-00
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 67457-902-10
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| 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 |
$0.81
|
| 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 Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
IP
|
$0.66
|
|
|
Service Code
|
NDC 55150-221-10
|
| Hospital Charge Code |
1720734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.45
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
OP
|
$1,310.98
|
|
|
Service Code
|
CPT J7307
|
| Hospital Charge Code |
ERX77012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$2,657.24 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,657.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$900.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,114.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$721.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$983.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,164.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,114.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,114.33
|
| Rate for Payer: Cash Price |
$589.94
|
| Rate for Payer: Cash Price |
$589.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$603.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,114.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,114.33
|
| Rate for Payer: Dignity Health Senior |
$1,114.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$839.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.98
|
| Rate for Payer: Heritage Provider Network Senior |
$606.98
|
| Rate for Payer: IEHP Medi-Cal |
$1,803.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$631.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.74
|
| Rate for Payer: Multiplan Commercial |
$983.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$477.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$438.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,114.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1,114.33
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
IP
|
$1,310.98
|
|
|
Service Code
|
CPT J7307
|
| Hospital Charge Code |
ERX77012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$983.24 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$900.64
|
| Rate for Payer: Cash Price |
$589.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$603.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.53
|
| Rate for Payer: Heritage Provider Network Senior |
$887.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.74
|
| Rate for Payer: Multiplan Commercial |
$983.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$477.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$438.00
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.25
|
|
|
Service Code
|
NDC 68001-265-25
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.55
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-08
|
| Hospital Charge Code |
NDG10000B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.70
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-01
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-01
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.54
|
| Rate for Payer: Dignity Health Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.25
|
|
|
Service Code
|
NDC 68001-265-25
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: Dignity Health Senior |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-08
|
| Hospital Charge Code |
NDG10000B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: Dignity Health Senior |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-05
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.54
|
| Rate for Payer: Dignity Health Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
OP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-31
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: Dignity Health Senior |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 16729-114-31
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.70
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
IP
|
$2.99
|
|
|
Service Code
|
NDC 63323-104-05
|
| Hospital Charge Code |
NDG10000A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.00
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
OP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$150.89 |
| Rate for Payer: Adventist Health Commercial |
$18.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.82
|
| Rate for Payer: Blue Shield of California Commercial |
$76.84
|
| Rate for Payer: Blue Shield of California EPN |
$76.84
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.27
|
| Rate for Payer: Dignity Health Senior |
$84.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.86
|
| Rate for Payer: Heritage Provider Network Senior |
$41.86
|
| Rate for Payer: Humana Medicare |
$76.61
|
| Rate for Payer: IEHP Medicare Advantage |
$76.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.53
|
| Rate for Payer: Multiplan Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.27
|
| Rate for Payer: TriValley Medical Group Senior |
$76.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.27
|
| Rate for Payer: Vantage Medical Group Senior |
$76.61
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
IP
|
$90.40
|
|
|
Service Code
|
CPT J8560
|
| Hospital Charge Code |
1711528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Adventist Health Commercial |
$18.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.10
|
| Rate for Payer: Cash Price |
$40.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.20
|
| Rate for Payer: Heritage Provider Network Senior |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$67.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.20
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994-0802-72
|
| Hospital Charge Code |
ERX4080272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
IP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.09
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.95
|
| Rate for Payer: Heritage Provider Network Senior |
$9.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
OP
|
$14.69
|
|
|
Service Code
|
NDC 59676-570-01
|
| Hospital Charge Code |
1712396
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.02
|
| Rate for Payer: Blue Shield of California Commercial |
$9.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.62
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.49
|
| Rate for Payer: Dignity Health Senior |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.09
|
| Rate for Payer: Heritage Provider Network Senior |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Vantage Medical Group Senior |
$12.49
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
IP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Adventist Health Commercial |
$5.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.18
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Heritage Provider Network Senior |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$22.03
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
OP
|
$29.37
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
ERX108431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Adventist Health Commercial |
$5.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.03
|
| Rate for Payer: Blue Shield of California Commercial |
$18.24
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.96
|
| Rate for Payer: Dignity Health Senior |
$24.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.18
|
| Rate for Payer: Heritage Provider Network Senior |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$22.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.96
|
| Rate for Payer: Vantage Medical Group Senior |
$24.96
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
CPT J7527
|
| Hospital Charge Code |
ERX4081261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.15
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Senior |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Senior |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
