|
EPINEPHRINE IV INFUSION IN NS (LL) [40820174]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 9940-8201-72
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
EPINEPHRINE IV INFUSION IN NS (LL) [40820174]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 9940-8201-72
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$5.76
|
| Rate for Payer: Cigna of CA PPO |
$6.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.97
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.42
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.42
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.40
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
|
IP
|
$2.31
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
|
OP
|
$2.31
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 69367-307-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 69367-307-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Blue Shield of California Commercial |
$236.67
|
| Rate for Payer: Blue Shield of California Commercial |
$236.68
|
| Rate for Payer: Blue Shield of California Commercial |
$146.83
|
| Rate for Payer: Blue Shield of California EPN |
$155.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.69
|
| Rate for Payer: Blue Shield of California EPN |
$155.86
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$176.39
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Senior |
$128.28
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$128.28
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.36
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare HMO Rider |
$114.61
|
| Rate for Payer: United Healthcare HMO Rider |
$114.62
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
OP
|
$320.70
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$272.60 |
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$176.39
|
| Rate for Payer: Cash Price |
$176.39
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.36
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare HMO Rider |
$114.61
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare HMO Rider |
$114.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Blue Shield of California Commercial |
$146.83
|
| Rate for Payer: Blue Shield of California EPN |
$96.69
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.28 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Blue Shield of California Commercial |
$473.35
|
| Rate for Payer: Blue Shield of California EPN |
$311.72
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.56
|
| Rate for Payer: EPIC Health Plan Senior |
$256.56
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other HMO |
$234.30
|
| Rate for Payer: United Healthcare HMO Rider |
$229.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.06
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other HMO |
$234.30
|
| Rate for Payer: United Healthcare HMO Rider |
$229.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
OP
|
$39.79
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cigna of CA HMO |
$44.91
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.89
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other HMO |
$14.54
|
| Rate for Payer: United Healthcare All Other HMO |
$23.43
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
IP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$54.53 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$47.34
|
| Rate for Payer: Blue Shield of California Commercial |
$29.37
|
| Rate for Payer: Blue Shield of California EPN |
$19.34
|
| Rate for Payer: Blue Shield of California EPN |
$31.18
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cigna of CA HMO |
$44.91
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.66
|
| Rate for Payer: EPIC Health Plan Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Senior |
$25.66
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.89
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO |
$23.43
|
| Rate for Payer: United Healthcare All Other HMO |
$14.54
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.01
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$71.01
|
| Rate for Payer: Blue Shield of California Commercial |
$44.05
|
| Rate for Payer: Blue Shield of California EPN |
$29.01
|
| Rate for Payer: Blue Shield of California EPN |
$46.76
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.11
|
| Rate for Payer: United Healthcare All Other HMO |
$35.15
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.51
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
OP
|
$59.69
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$35.15
|
| Rate for Payer: United Healthcare HMO Rider |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.05
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.14
|
| Rate for Payer: United Healthcare All Other HMO |
$46.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8.45
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Blue Shield of California Commercial |
$94.67
|
| Rate for Payer: Blue Shield of California EPN |
$62.34
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.31
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.14
|
| Rate for Payer: United Healthcare All Other HMO |
$46.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.01
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.67
|
| Rate for Payer: United Healthcare All Other HMO |
$48.35
|
| Rate for Payer: United Healthcare HMO Rider |
$47.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.33
|
| Rate for Payer: Vantage Medical Group Senior |
$8.33
|
|
