|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
OP
|
$229.07
|
|
|
Service Code
|
CPT J0348
|
| Hospital Charge Code |
1753552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$125.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: BCBS Transplant Transplant |
$137.44
|
| Rate for Payer: Blue Shield of California Commercial |
$168.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Media |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$171.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.54
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.54
|
| Rate for Payer: United Healthcare All Other HMO |
$114.54
|
| Rate for Payer: United Healthcare HMO Rider |
$114.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$26,128.38
|
|
|
Service Code
|
APR-DRG 0594
|
| Min. Negotiated Rate |
$20,043.22 |
| Max. Negotiated Rate |
$26,128.38 |
| Rate for Payer: IEHP Medi-Cal |
$20,043.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,128.38
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$8,147.28
|
|
|
Service Code
|
APR-DRG 0591
|
| Min. Negotiated Rate |
$6,249.82 |
| Max. Negotiated Rate |
$8,147.28 |
| Rate for Payer: IEHP Medi-Cal |
$6,249.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,147.28
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$13,382.54
|
|
|
Service Code
|
APR-DRG 0592
|
| Min. Negotiated Rate |
$10,265.81 |
| Max. Negotiated Rate |
$13,382.54 |
| Rate for Payer: IEHP Medi-Cal |
$10,265.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,382.54
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$18,878.48
|
|
|
Service Code
|
APR-DRG 0593
|
| Min. Negotiated Rate |
$14,481.78 |
| Max. Negotiated Rate |
$18,878.48 |
| Rate for Payer: IEHP Medi-Cal |
$14,481.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,878.48
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$9,580.24
|
|
|
Service Code
|
APR-DRG 5471
|
| Min. Negotiated Rate |
$7,349.05 |
| Max. Negotiated Rate |
$9,580.24 |
| Rate for Payer: IEHP Medi-Cal |
$7,349.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,580.24
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$13,394.94
|
|
|
Service Code
|
APR-DRG 5472
|
| Min. Negotiated Rate |
$10,275.33 |
| Max. Negotiated Rate |
$13,394.94 |
| Rate for Payer: IEHP Medi-Cal |
$10,275.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,394.94
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$19,903.54
|
|
|
Service Code
|
APR-DRG 5473
|
| Min. Negotiated Rate |
$15,268.11 |
| Max. Negotiated Rate |
$19,903.54 |
| Rate for Payer: IEHP Medi-Cal |
$15,268.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,903.54
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$39,111.71
|
|
|
Service Code
|
APR-DRG 5474
|
| Min. Negotiated Rate |
$30,002.80 |
| Max. Negotiated Rate |
$39,111.71 |
| Rate for Payer: IEHP Medi-Cal |
$30,002.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,111.71
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
IP
|
$3,741.99
|
|
|
Service Code
|
APR-DRG 5661
|
| Min. Negotiated Rate |
$2,870.50 |
| Max. Negotiated Rate |
$3,741.99 |
| Rate for Payer: IEHP Medi-Cal |
$2,870.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,741.99
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
IP
|
$17,881.09
|
|
|
Service Code
|
APR-DRG 5664
|
| Min. Negotiated Rate |
$13,716.68 |
| Max. Negotiated Rate |
$17,881.09 |
| Rate for Payer: IEHP Medi-Cal |
$13,716.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,881.09
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
IP
|
$5,034.85
|
|
|
Service Code
|
APR-DRG 5662
|
| Min. Negotiated Rate |
$3,862.26 |
| Max. Negotiated Rate |
$5,034.85 |
| Rate for Payer: IEHP Medi-Cal |
$3,862.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,034.85
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
IP
|
$7,327.94
|
|
|
Service Code
|
APR-DRG 5663
|
| Min. Negotiated Rate |
$5,621.30 |
| Max. Negotiated Rate |
$7,327.94 |
| Rate for Payer: IEHP Medi-Cal |
$5,621.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,327.94
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
1771241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.29
|
| Rate for Payer: BCBS Transplant Transplant |
$33.52
|
| Rate for Payer: Blue Shield of California Commercial |
$41.18
|
| Rate for Payer: Blue Shield of California EPN |
$32.63
|
| Rate for Payer: Cash Price |
$25.14
|
| Rate for Payer: Cigna of CA HMO |
$35.76
|
| Rate for Payer: Cigna of CA PPO |
$41.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.49
|
| Rate for Payer: Dignity Health Media |
$47.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$41.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$44.70
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.94
|
| Rate for Payer: United Healthcare All Other HMO |
$27.94
|
| Rate for Payer: United Healthcare HMO Rider |
$27.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Vantage Medical Group Senior |
$47.49
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
1771241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Cash Price |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$44.70
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX76368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX76368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Media |
$1.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.21
|
| Rate for Payer: IEHP Medi-Cal |
$2.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Media |
$1.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.13
|
| Rate for Payer: IEHP Medi-Cal |
$2.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.10
|
| Rate for Payer: IEHP Medicare Advantage |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN [88338]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN [88338]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
