|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 67877-321-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0904-5855-61
|
| 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: Cash Price |
$0.05
|
| 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 Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 59651-362-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| 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 |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 64380-807-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0904-5855-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0904-5855-61
|
| 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 Gatekeeper |
$0.05
|
| 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: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0904-5855-60
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Senior |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 67877-321-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Senior |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| 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 |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 60687-468-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 59651-362-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
OP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$146.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$150.56
|
| Rate for Payer: Cash Price |
$150.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$125.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.68
|
| Rate for Payer: Dignity Health Senior |
$232.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.74
|
| Rate for Payer: Heritage Provider Network Senior |
$126.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$130.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.62
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$109.50
|
| Rate for Payer: TriValley Medical Group Senior |
$109.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$90.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.68
|
| Rate for Payer: Vantage Medical Group Senior |
$232.68
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
IP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$205.31 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Cash Price |
$150.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$125.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.74
|
| Rate for Payer: Heritage Provider Network Senior |
$126.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.44
|
| Rate for Payer: Multiplan Commercial |
$205.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$90.64
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
IP
|
$67.18
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$50.38 |
| Rate for Payer: Adventist Health Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$36.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.10
|
| Rate for Payer: Heritage Provider Network Senior |
$31.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.24
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
OP
|
$67.18
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$788.69 |
| Rate for Payer: Adventist Health Commercial |
$13.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$273.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$788.69
|
| Rate for Payer: Blue Shield of California Commercial |
$310.61
|
| Rate for Payer: Blue Shield of California EPN |
$310.61
|
| Rate for Payer: Cash Price |
$36.95
|
| Rate for Payer: Cash Price |
$36.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$273.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.96
|
| Rate for Payer: Dignity Health Senior |
$240.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.10
|
| Rate for Payer: Heritage Provider Network Senior |
$31.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$276.01
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.87
|
| Rate for Payer: TriValley Medical Group Senior |
$26.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$273.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.96
|
| Rate for Payer: Vantage Medical Group Senior |
$240.96
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$12.94
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$8.84
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5.75
|
| Rate for Payer: Heritage Provider Network Senior |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.28
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$133.99 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.99
|
| Rate for Payer: Blue Shield of California Commercial |
$52.77
|
| Rate for Payer: Blue Shield of California Commercial |
$52.77
|
| Rate for Payer: Blue Shield of California Commercial |
$52.77
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| Rate for Payer: Blue Shield of California EPN |
$52.77
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$8.84
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$8.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: Dignity Health Senior |
$13.66
|
| Rate for Payer: Dignity Health Senior |
$10.56
|
| Rate for Payer: Dignity Health Senior |
$11.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.99
|
| Rate for Payer: Heritage Provider Network Senior |
$7.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.69
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Senior |
$4.97
|
| Rate for Payer: TriValley Medical Group Senior |
$6.43
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
OP
|
$61.23
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$52.05 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.92
|
| Rate for Payer: Blue Shield of California Commercial |
$37.35
|
| Rate for Payer: Blue Shield of California EPN |
$29.88
|
| Rate for Payer: Cash Price |
$33.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.05
|
| Rate for Payer: Dignity Health Senior |
$52.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.35
|
| Rate for Payer: Heritage Provider Network Senior |
$28.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.86
|
| Rate for Payer: Multiplan Commercial |
$45.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.49
|
| Rate for Payer: TriValley Medical Group Senior |
$24.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.05
|
| Rate for Payer: Vantage Medical Group Senior |
$52.05
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
IP
|
$61.23
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Cash Price |
$33.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.35
|
| Rate for Payer: Heritage Provider Network Senior |
$28.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$45.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.27
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$95.16 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.16
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.87
|
| Rate for Payer: Dignity Health Senior |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.87
|
|
|
IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION [87925]
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.73
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
IP
|
$44.09
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.07 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.41
|
| Rate for Payer: Heritage Provider Network Senior |
$20.41
|
| Rate for Payer: Heritage Provider Network Senior |
$32.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION [10248]
|
Facility
|
OP
|
$69.66
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$95.16 |
| Rate for Payer: Adventist Health Commercial |
$13.93
|
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.16
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California Commercial |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.48
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.21
|
| Rate for Payer: Dignity Health Senior |
$37.48
|
| Rate for Payer: Dignity Health Senior |
$59.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.41
|
| Rate for Payer: Heritage Provider Network Senior |
$20.41
|
| Rate for Payer: Heritage Provider Network Senior |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$52.24
|
| Rate for Payer: Multiplan Commercial |
$33.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.64
|
| Rate for Payer: TriValley Medical Group Senior |
$17.64
|
| Rate for Payer: TriValley Medical Group Senior |
$27.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.21
|
| Rate for Payer: Vantage Medical Group Senior |
$37.48
|
| Rate for Payer: Vantage Medical Group Senior |
$59.21
|
|
