|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California Commercial |
$97.68
|
| Rate for Payer: Blue Shield of California EPN |
$64.33
|
| 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: EPIC Health Plan Commercial |
$52.94
|
| Rate for Payer: EPIC Health Plan Senior |
$52.94
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| 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: 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
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$264.72
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Blue Shield of California Commercial |
$195.36
|
| Rate for Payer: Blue Shield of California EPN |
$128.65
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.89
|
| Rate for Payer: EPIC Health Plan Senior |
$105.89
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.53
|
| Rate for Payer: Multiplan Commercial |
$211.78
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.35
|
| Rate for Payer: United Healthcare All Other HMO |
$96.70
|
| Rate for Payer: United Healthcare HMO Rider |
$94.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$264.72
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.63
|
| 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 |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| 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 |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| 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 |
$176.57
|
| 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 |
$63.53
|
| 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 |
$211.78
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.35
|
| Rate for Payer: United Healthcare All Other HMO |
$96.70
|
| Rate for Payer: United Healthcare HMO Rider |
$94.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
| 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
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California EPN |
$12.86
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.59
|
| Rate for Payer: EPIC Health Plan Senior |
$10.59
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$21.18
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.67
|
| Rate for Payer: United Healthcare HMO Rider |
$9.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.67
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$29.97 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.36
|
| 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 |
$14.56
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| 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 |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| 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 |
$17.66
|
| 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 |
$6.35
|
| 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 |
$21.18
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.67
|
| Rate for Payer: United Healthcare HMO Rider |
$9.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.67
|
| 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
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.05
|
| 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 |
$21.84
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| 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 |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| 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 |
$26.49
|
| 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 |
$9.53
|
| 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 |
$31.77
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.51
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| 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
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Blue Shield of California Commercial |
$29.31
|
| Rate for Payer: Blue Shield of California EPN |
$19.30
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Senior |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$31.77
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.51
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$450.02 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$347.26
|
| 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 |
$291.19
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| 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 |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| 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 |
$353.14
|
| 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 |
$127.07
|
| 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 |
$423.55
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.70
|
| Rate for Payer: United Healthcare All Other HMO |
$193.40
|
| Rate for Payer: United Healthcare HMO Rider |
$189.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.39
|
| 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
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
IP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$450.02 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Blue Shield of California Commercial |
$390.73
|
| Rate for Payer: Blue Shield of California EPN |
$257.31
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.78
|
| Rate for Payer: EPIC Health Plan Senior |
$211.78
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.07
|
| Rate for Payer: Multiplan Commercial |
$423.55
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.70
|
| Rate for Payer: United Healthcare All Other HMO |
$193.40
|
| Rate for Payer: United Healthcare HMO Rider |
$189.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.39
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$39.07
|
| Rate for Payer: Blue Shield of California EPN |
$25.73
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.18
|
| Rate for Payer: EPIC Health Plan Senior |
$21.18
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$42.35
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.87
|
| Rate for Payer: United Healthcare All Other HMO |
$19.34
|
| Rate for Payer: United Healthcare HMO Rider |
$18.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.72
|
| 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 |
$29.12
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| 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 |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| 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 |
$35.31
|
| 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 |
$12.71
|
| 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 |
$42.35
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.87
|
| Rate for Payer: United Healthcare All Other HMO |
$19.34
|
| Rate for Payer: United Healthcare HMO Rider |
$18.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| 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
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Adventist Health Commercial |
$13.26
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.77
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cigna of CA HMO |
$46.42
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$56.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$39.79
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.38
|
| Rate for Payer: Multiplan Commercial |
$53.05
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$33.16
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: Prime Health Services Commercial |
$56.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.89
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$24.22
|
| Rate for Payer: United Healthcare HMO Rider |
$23.70
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.36
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
| Rate for Payer: Vantage Medical Group Senior |
$56.36
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Adventist Health Commercial |
$13.26
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$48.94
|
| Rate for Payer: Blue Shield of California Commercial |
$39.41
|
| Rate for Payer: Blue Shield of California EPN |
$25.95
|
| Rate for Payer: Blue Shield of California EPN |
$32.23
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cigna of CA HMO |
$46.42
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Galaxy Health WC |
$56.36
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Global Benefits Group Commercial |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$53.05
|
| Rate for Payer: Networks By Design Commercial |
$33.16
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$56.36
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.89
|
| Rate for Payer: United Healthcare All Other HMO |
$24.22
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$23.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.72
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$16.55
|
| Rate for Payer: Blue Shield of California EPN |
$10.90
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.42
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.35
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$50.77 |
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.70
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.42
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.77
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$12.34
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California Commercial |
$39.98
|
| Rate for Payer: Blue Shield of California EPN |
$26.33
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$19.79
|
| Rate for Payer: United Healthcare HMO Rider |
$19.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.74
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$50.77 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.77
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$19.79
|
| Rate for Payer: United Healthcare HMO Rider |
$19.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.86
|
| Rate for Payer: Blue Shield of California Commercial |
$12.75
|
| Rate for Payer: Blue Shield of California EPN |
$12.75
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.87
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.93
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.86
|
| Rate for Payer: Blue Shield of California Commercial |
$12.75
|
| Rate for Payer: Blue Shield of California EPN |
$12.75
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
OP
|
$80.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Adventist Health Commercial |
$16.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cigna of CA HMO |
$56.35
|
| Rate for Payer: Cigna of CA PPO |
$56.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.20
|
| Rate for Payer: EPIC Health Plan Senior |
$32.20
|
| Rate for Payer: Galaxy Health WC |
$68.42
|
| Rate for Payer: Global Benefits Group Commercial |
$48.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$64.40
|
| Rate for Payer: Networks By Design Commercial |
$40.25
|
| Rate for Payer: Prime Health Services Commercial |
$68.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.21
|
| Rate for Payer: United Healthcare All Other HMO |
$29.41
|
| Rate for Payer: United Healthcare HMO Rider |
$28.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.42
|
| Rate for Payer: Vantage Medical Group Senior |
$68.42
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$68.42 |
| Rate for Payer: Adventist Health Commercial |
$16.10
|
| Rate for Payer: Blue Shield of California Commercial |
$59.41
|
| Rate for Payer: Blue Shield of California EPN |
$39.12
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cigna of CA HMO |
$56.35
|
| Rate for Payer: Cigna of CA PPO |
$56.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.20
|
| Rate for Payer: EPIC Health Plan Senior |
$32.20
|
| Rate for Payer: Galaxy Health WC |
$68.42
|
| Rate for Payer: Global Benefits Group Commercial |
$48.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$64.40
|
| Rate for Payer: Networks By Design Commercial |
$40.25
|
| Rate for Payer: Prime Health Services Commercial |
$68.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.21
|
| Rate for Payer: United Healthcare All Other HMO |
$29.41
|
| Rate for Payer: United Healthcare HMO Rider |
$28.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.36
|
|
