|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.19
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Multiplan Commercial |
$24.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.89
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE [28025]
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.68
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$16.06
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Senior |
$15.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.03
|
| Rate for Payer: Multiplan Commercial |
$24.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.16
|
| Rate for Payer: TriValley Medical Group Senior |
$13.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.96
|
| Rate for Payer: Vantage Medical Group Senior |
$27.96
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 200 TOPICAL SPONGE [28026]
|
Facility
|
OP
|
$106.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Adventist Health Commercial |
$21.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.65
|
| Rate for Payer: Blue Shield of California Commercial |
$64.78
|
| Rate for Payer: Blue Shield of California EPN |
$51.83
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.17
|
| Rate for Payer: Heritage Provider Network Senior |
$49.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.34
|
| Rate for Payer: Multiplan Commercial |
$79.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.48
|
| Rate for Payer: TriValley Medical Group Senior |
$42.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.27
|
| Rate for Payer: Vantage Medical Group Senior |
$90.27
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 200 TOPICAL SPONGE [28026]
|
Facility
|
IP
|
$106.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$79.65 |
| Rate for Payer: Adventist Health Commercial |
$21.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.39
|
| Rate for Payer: Cash Price |
$47.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.17
|
| Rate for Payer: Heritage Provider Network Senior |
$49.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.55
|
| Rate for Payer: Multiplan Commercial |
$79.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.16
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]
|
Facility
|
IP
|
$37.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$27.79 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.86
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.26
|
| Rate for Payer: Multiplan Commercial |
$27.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.27
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE [28024]
|
Facility
|
OP
|
$37.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$31.49 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.79
|
| Rate for Payer: Blue Shield of California Commercial |
$22.60
|
| Rate for Payer: Blue Shield of California EPN |
$18.08
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$27.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.82
|
| Rate for Payer: TriValley Medical Group Senior |
$14.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.49
|
| Rate for Payer: Vantage Medical Group Senior |
$31.49
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
HCPCS J9196
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$26.87 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.87
|
| Rate for Payer: Blue Shield of California Commercial |
$11.31
|
| Rate for Payer: Blue Shield of California EPN |
$11.31
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.33
|
| Rate for Payer: Heritage Provider Network Senior |
$7.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$11.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.34
|
| Rate for Payer: TriValley Medical Group Senior |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [220785]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
HCPCS J9196
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.20
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.33
|
| Rate for Payer: Heritage Provider Network Senior |
$7.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$11.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.24
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [191075]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Multiplan Commercial |
$1.55
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.33
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Senior |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.69
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION [191075]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Senior |
$0.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$1.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1.76
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]
|
Facility
|
OP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.58
|
| Rate for Payer: Multiplan Commercial |
$41.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.05
|
| Rate for Payer: TriValley Medical Group Senior |
$22.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.85
|
| Rate for Payer: Vantage Medical Group Senior |
$46.85
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [17122]
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.50
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$41.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.25
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [400398]
|
Facility
|
OP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.58
|
| Rate for Payer: Multiplan Commercial |
$41.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.05
|
| Rate for Payer: TriValley Medical Group Senior |
$22.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.85
|
| Rate for Payer: Vantage Medical Group Senior |
$46.85
|
|
|
GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION [400398]
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.50
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.52
|
| Rate for Payer: Heritage Provider Network Senior |
$25.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$41.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.25
|
|
|
GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION [191077]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.13
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
|
|
GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION [191077]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Senior |
$0.46
|
| Rate for Payer: TriValley Medical Group Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.97
|
|
|
GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]
|
Facility
|
OP
|
$14.46
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Senior |
$6.69
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$6.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$10.01
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$4.41
|
| Rate for Payer: TriValley Medical Group Senior |
$5.34
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.76
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.38
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.34
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
|
|
GEMCITABINE 200 MG INTRAVENOUS SOLUTION [17121]
|
Facility
|
IP
|
$11.03
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.27 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.18
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$5.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.18
|
| Rate for Payer: Heritage Provider Network Senior |
$6.69
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$10.01
|
| Rate for Payer: Multiplan Commercial |
$8.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.96
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Senior |
$0.70
|
| Rate for Payer: TriValley Medical Group Senior |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1.50
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION [191076]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Adventist Health Commercial |
$0.35
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.33
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Senior |
$0.96
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.58
|
|
|
GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]
|
Facility
|
OP
|
$140.94
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$257.37 |
| Rate for Payer: Adventist Health Commercial |
$28.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.26
|
| Rate for Payer: Heritage Provider Network Senior |
$65.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$67.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.66
|
| Rate for Payer: Multiplan Commercial |
$105.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.38
|
| Rate for Payer: TriValley Medical Group Senior |
$56.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.80
|
| Rate for Payer: Vantage Medical Group Senior |
$119.80
|
|
|
GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION [105417]
|
Facility
|
IP
|
$140.94
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$105.70 |
| Rate for Payer: Adventist Health Commercial |
$28.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.77
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.26
|
| Rate for Payer: Heritage Provider Network Senior |
$65.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.23
|
| Rate for Payer: Multiplan Commercial |
$105.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.67
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 6068722401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 6586262460
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Vantage Medical Group Senior |
$0.18
|
|
|
GEMFIBROZIL 600 MG TABLET [3378]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 6068722411
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
