|
ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN [207372]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX207372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN [207372]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX207372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
1720668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Media |
$1.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.21
|
| Rate for Payer: IEHP Medi-Cal |
$2.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
1720668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
OP
|
$1.61
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$0.97
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Media |
$1.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1.97
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1.95
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Media |
$1.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.13
|
| Rate for Payer: IEHP Medi-Cal |
$2.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.10
|
| Rate for Payer: IEHP Medicare Advantage |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Media |
$1.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.21
|
| Rate for Payer: IEHP Medi-Cal |
$2.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
OP
|
$2.42
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408376367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
IP
|
$2.42
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408376367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408078225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408078225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
OP
|
$2.42
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ER408378225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
IP
|
$2.42
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ER408378225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408099576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408099576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Media |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.48
|
| Rate for Payer: IEHP Medi-Cal |
$2.45
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2.45
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 350 UNIT-650 UNIT INTRAVENOUS SOLN [225932]
|
Facility
OP
|
$2.70
|
|
|
Service Code
|
CPT J7198
|
| Hospital Charge Code |
ERX225932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$14.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.76
|
| Rate for Payer: BCBS Transplant Transplant |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Media |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.27
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.72
|
| Rate for Payer: IEHP Medi-Cal |
$3.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3.67
|
| Rate for Payer: IEHP Medicare Advantage |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.35
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
