|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
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) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
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) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
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) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
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) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
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) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
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
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.59
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
IP
|
$5.35
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.95
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$3.75
|
| Rate for Payer: Cigna of CA PPO |
$3.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$3.75
|
| Rate for Payer: Cigna of CA PPO |
$3.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4.09
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.50
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
IP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0893-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
OP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0893-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.49
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other HMO |
$6.07
|
| Rate for Payer: United Healthcare HMO Rider |
$6.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.31
|
| Rate for Payer: Vantage Medical Group Senior |
$10.31
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0894-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0894-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.49
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other HMO |
$6.07
|
| Rate for Payer: United Healthcare HMO Rider |
$6.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.31
|
| Rate for Payer: Vantage Medical Group Senior |
$10.31
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0894-21
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0894-70
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.49
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other HMO |
$6.07
|
| Rate for Payer: United Healthcare HMO Rider |
$6.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.31
|
| Rate for Payer: Vantage Medical Group Senior |
$10.31
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0894-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.49
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other HMO |
$6.07
|
| Rate for Payer: United Healthcare HMO Rider |
$6.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.31
|
| Rate for Payer: Vantage Medical Group Senior |
$10.31
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$12.13
|
|
|
Service Code
|
NDC 0003-0894-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO |
$8.49
|
| Rate for Payer: Cigna of CA PPO |
$8.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Senior |
$4.85
|
| Rate for Payer: Galaxy Health WC |
$10.31
|
| Rate for Payer: Global Benefits Group Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$9.70
|
| Rate for Payer: Networks By Design Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.31
|
|
|
APRACLONIDINE 0.5 % EYE DROPS [9119]
|
Facility
|
OP
|
$15.42
|
|
|
Service Code
|
NDC 61314-665-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.47
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$10.79
|
| Rate for Payer: Cigna of CA PPO |
$10.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.71
|
| Rate for Payer: United Healthcare All Other HMO |
$7.71
|
| Rate for Payer: United Healthcare HMO Rider |
$7.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.11
|
|
|
APRACLONIDINE 0.5 % EYE DROPS [9119]
|
Facility
|
IP
|
$15.42
|
|
|
Service Code
|
NDC 61314-665-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.38
|
| Rate for Payer: Blue Shield of California EPN |
$7.49
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$10.79
|
| Rate for Payer: Cigna of CA PPO |
$10.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Senior |
$6.17
|
| Rate for Payer: Galaxy Health WC |
$13.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$12.34
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Prime Health Services Commercial |
$13.11
|
|
|
APR-DRG 41.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$12,494.23
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$9,978.94 |
| Max. Negotiated Rate |
$12,494.23 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,978.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,494.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,179.05
|
|
|
APR-DRG 41.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$9,736.76
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$7,776.60 |
| Max. Negotiated Rate |
$9,736.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,776.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,736.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,711.84
|
|
|
APR-DRG 41.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$35,968.94
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$28,727.82 |
| Max. Negotiated Rate |
$35,968.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28,727.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,968.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,182.73
|
|
