|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
IP
|
$103.86
|
|
|
Service Code
|
HCPCS J8560
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$77.89 |
| Rate for Payer: Adventist Health Commercial |
$20.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.89
|
| Rate for Payer: Cash Price |
$46.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.09
|
| Rate for Payer: Heritage Provider Network Senior |
$48.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.96
|
| Rate for Payer: Multiplan Commercial |
$77.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.39
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
OP
|
$103.86
|
|
|
Service Code
|
HCPCS J8560
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Adventist Health Commercial |
$20.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.40
|
| 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 |
$46.74
|
| Rate for Payer: Cash Price |
$46.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.09
|
| Rate for Payer: Heritage Provider Network Senior |
$48.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$77.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.54
|
| Rate for Payer: TriValley Medical Group Senior |
$41.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.06
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994080272
|
| Hospital Charge Code |
901700029
|
|
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 |
$0.64
|
| 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 Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994080272
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
OP
|
$14.98
|
|
|
Service Code
|
NDC 5967657001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.31
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.27
|
| Rate for Payer: Heritage Provider Network Senior |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$11.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$12.73
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
IP
|
$14.98
|
|
|
Service Code
|
NDC 5967657001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.23
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 5967657101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.29
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.28
|
| Rate for Payer: Heritage Provider Network Senior |
$20.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$22.47
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 5967657101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.99
|
| Rate for Payer: Blue Shield of California Commercial |
$18.28
|
| Rate for Payer: Blue Shield of California EPN |
$14.62
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.55
|
| Rate for Payer: Heritage Provider Network Senior |
$18.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$22.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.47
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
EUCALYPTUS OIL-ALOE EXTR-LAVENDER,ROSEMARY OIL-PETROLATUM TOP OINTMENT [9125]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 2390000617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
EUCALYPTUS OIL-ALOE EXTR-LAVENDER,ROSEMARY OIL-PETROLATUM TOP OINTMENT [9125]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 2390000617
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
OP
|
$40.31
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Senior |
$18.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.22
|
| Rate for Payer: Multiplan Commercial |
$30.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Senior |
$16.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.26
|
| Rate for Payer: Vantage Medical Group Senior |
$34.26
|
|
|
EVEROLIMUS 0.3 MG/ML SPECIAL DILUTION (FROM 0.75 MG TAB) [4081261]
|
Facility
|
IP
|
$40.31
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$30.23 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Senior |
$18.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$30.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.35
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.64
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.22
|
| Rate for Payer: Heritage Provider Network Senior |
$6.22
|
| Rate for Payer: Heritage Provider Network Senior |
$6.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$10.06
|
| Rate for Payer: Multiplan Commercial |
$10.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.45
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET [104555]
|
Facility
|
OP
|
$13.42
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$1.12
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Senior |
$6.22
|
| Rate for Payer: Heritage Provider Network Senior |
$6.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$10.07
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$10.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5.37
|
| Rate for Payer: TriValley Medical Group Senior |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.42
|
| Rate for Payer: Vantage Medical Group Senior |
$11.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$11.42
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
IP
|
$26.89
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Adventist Health Commercial |
$5.38
|
| Rate for Payer: Adventist Health Commercial |
$5.37
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.34
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$12.08
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.45
|
| Rate for Payer: Heritage Provider Network Senior |
$12.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8.81
|
| Rate for Payer: Heritage Provider Network Senior |
$12.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$20.13
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.26
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.5 MG TABLET [104877]
|
Facility
|
OP
|
$26.89
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Adventist Health Commercial |
$5.38
|
| Rate for Payer: Adventist Health Commercial |
$5.37
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$12.08
|
| Rate for Payer: Cash Price |
$12.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.81
|
| Rate for Payer: Heritage Provider Network Senior |
$12.45
|
| Rate for Payer: Heritage Provider Network Senior |
$12.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$20.13
|
| Rate for Payer: Multiplan Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$3.94
|
| Rate for Payer: TriValley Medical Group Senior |
$10.76
|
| Rate for Payer: TriValley Medical Group Senior |
$7.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$22.86
|
| Rate for Payer: Vantage Medical Group Senior |
$22.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
IP
|
$40.31
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$30.23 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Senior |
$18.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$30.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.35
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET [104556]
|
Facility
|
OP
|
$40.31
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.66
|
| Rate for Payer: Heritage Provider Network Senior |
$18.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.22
|
| Rate for Payer: Multiplan Commercial |
$30.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Senior |
$16.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.26
|
| Rate for Payer: Vantage Medical Group Senior |
$34.26
|
|
|
EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 50435
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,298.00 |
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,124.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$910.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,124.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
|
Facility
|
OP
|
$8,962.13
|
|
|
Service Code
|
CPT 69110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| 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 |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 30130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5,245.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,102.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,690.65
|
| Rate for Payer: TriValley Medical Group Senior |
$4,690.65
|
| 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 |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
