|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| 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 |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| 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 |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| 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) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| 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) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| 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: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.07
|
| 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 |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| 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 |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| 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
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$15.07 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.07
|
| 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 |
$3.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| 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 |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| 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
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA PPO |
$3.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.41
|
| Rate for Payer: Networks By Design Commercial |
$2.75
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA PPO |
$3.86
|
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: Blue Shield of California Commercial |
$5.02
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$4.41
|
| Rate for Payer: Networks By Design Commercial |
$2.75
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
OP
|
$1,376.95
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.39 |
| Max. Negotiated Rate |
$5,907.99 |
| Rate for Payer: Adventist Health Commercial |
$275.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,907.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,586.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,163.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,057.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$626.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,279.39
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cigna of CA HMO |
$963.87
|
| Rate for Payer: Cigna of CA PPO |
$963.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,163.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,163.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$963.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,163.57
|
| Rate for Payer: Galaxy Health WC |
$1,170.41
|
| Rate for Payer: Global Benefits Group Commercial |
$826.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,734.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,057.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,057.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$874.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$499.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,480.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,332.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.44
|
| Rate for Payer: Multiplan Commercial |
$1,101.56
|
| Rate for Payer: Networks By Design Commercial |
$688.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,170.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$826.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.77
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$492.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,057.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,163.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1,163.57
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
IP
|
$1,376.95
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.39 |
| Max. Negotiated Rate |
$1,170.41 |
| Rate for Payer: Adventist Health Commercial |
$275.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,058.87
|
| Rate for Payer: Blue Shield of California Commercial |
$698.11
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cigna of CA HMO |
$963.87
|
| Rate for Payer: Cigna of CA PPO |
$963.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$963.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.78
|
| Rate for Payer: EPIC Health Plan Senior |
$550.78
|
| Rate for Payer: Galaxy Health WC |
$1,170.41
|
| Rate for Payer: Global Benefits Group Commercial |
$826.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$874.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$812.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.47
|
| Rate for Payer: Multiplan Commercial |
$1,101.56
|
| Rate for Payer: Networks By Design Commercial |
$688.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,170.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.77
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$492.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.95
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) 120 MG SOLUTION FOR INJECTION [222871]
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$9,357.80 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$871.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,116.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,584.00
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$1,108.80
|
| Rate for Payer: Cigna of CA PPO |
$1,108.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,346.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,346.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$633.60
|
| Rate for Payer: EPIC Health Plan Senior |
$633.60
|
| Rate for Payer: Galaxy Health WC |
$1,346.40
|
| Rate for Payer: Global Benefits Group Commercial |
$950.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,274.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,005.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,357.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$934.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.80
|
| Rate for Payer: Multiplan Commercial |
$1,267.20
|
| Rate for Payer: Networks By Design Commercial |
$792.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,346.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$950.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$950.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.48
|
| Rate for Payer: United Healthcare All Other HMO |
$578.64
|
| Rate for Payer: United Healthcare HMO Rider |
$566.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,346.40
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) 120 MG SOLUTION FOR INJECTION [222871]
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$1,346.40 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,218.10
|
| Rate for Payer: Blue Shield of California Commercial |
$803.09
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$1,108.80
|
| Rate for Payer: Cigna of CA PPO |
$1,108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$633.60
|
| Rate for Payer: EPIC Health Plan Senior |
$633.60
|
| Rate for Payer: Galaxy Health WC |
$1,346.40
|
| Rate for Payer: Global Benefits Group Commercial |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,005.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$934.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.16
|
| Rate for Payer: Multiplan Commercial |
$1,267.20
|
| Rate for Payer: Networks By Design Commercial |
$792.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,346.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.48
|
| Rate for Payer: United Healthcare All Other HMO |
$578.64
|
| Rate for Payer: United Healthcare HMO Rider |
$566.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.76
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$208,510.42
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$208,510.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208,510.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$201,296.75
|
| Rate for Payer: EPIC Health Plan Senior |
$134,197.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$121,998.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$170,797.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163,477.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$127,168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127,168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,927.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,806.00
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$154,189.56
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$154,189.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128,030.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$154,189.56
|
| Rate for Payer: EPIC Health Plan Senior |
$102,793.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$93,448.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130,827.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125,220.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$79,046.00
|
| Rate for Payer: United Healthcare All Other HMO |
$79,046.00
|
| Rate for Payer: United Healthcare HMO Rider |
$52,792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48,365.00
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089321
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089321
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089470
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089470
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO |
$4.84
|
| Rate for Payer: Cigna of CA PPO |
$4.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Senior |
$2.76
|
| Rate for Payer: Galaxy Health WC |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$4.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Networks By Design Commercial |
$4.49
|
| Rate for Payer: Prime Health Services Commercial |
$5.87
|
|
