|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$44.70
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.31
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cigna of CA HMO |
$35.76
|
| Rate for Payer: Cigna of CA PPO |
$41.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.11
|
| Rate for Payer: Multiplan Commercial |
$44.70
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.93
|
| Rate for Payer: United Healthcare All Other HMO |
$27.93
|
| Rate for Payer: United Healthcare HMO Rider |
$27.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Vantage Medical Group Senior |
$47.49
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Senior |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
HCPCS J7186
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS J7186
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: EPIC Health Plan Senior |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Senior |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Senior |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
|
