|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 4354754610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$97,438.04
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$97,438.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,073.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,438.04
|
| Rate for Payer: EPIC Health Plan Senior |
$64,958.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,053.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,674.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,131.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$108,459.38
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$108,459.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,903.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,459.38
|
| Rate for Payer: EPIC Health Plan Senior |
$72,306.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,732.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,026.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,082.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$92,882.97
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$92,882.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,291.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,882.97
|
| Rate for Payer: EPIC Health Plan Senior |
$61,921.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,292.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,809.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75,432.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$180,517.56
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$109,404.58 |
| Max. Negotiated Rate |
$180,517.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$173,010.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$180,517.56
|
| Rate for Payer: EPIC Health Plan Senior |
$120,345.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109,404.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153,166.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146,602.14
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$216,703.00
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$216,703.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$185,788.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$187,997.01
|
| Rate for Payer: EPIC Health Plan Senior |
$125,331.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113,937.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159,512.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152,676.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$216,703.00
|
| Rate for Payer: United Healthcare All Other HMO |
$216,703.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155,367.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142,342.00
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$163,729.19
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$163,729.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$144,328.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$163,729.19
|
| Rate for Payer: EPIC Health Plan Senior |
$109,152.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$99,229.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138,921.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132,967.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$162,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$162,712.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116,659.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106,879.00
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
|
IP
|
$3,421.37
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$684.27 |
| Max. Negotiated Rate |
$2,908.16 |
| Rate for Payer: Adventist Health Commercial |
$684.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,734.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,631.03
|
| Rate for Payer: Cash Price |
$1,539.62
|
| Rate for Payer: Cigna of CA HMO |
$2,394.96
|
| Rate for Payer: Cigna of CA PPO |
$2,394.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,394.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.55
|
| Rate for Payer: Galaxy Health WC |
$2,908.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,172.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,018.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.13
|
| Rate for Payer: Multiplan Commercial |
$2,737.10
|
| Rate for Payer: Networks By Design Commercial |
$1,710.68
|
| Rate for Payer: Prime Health Services Commercial |
$2,908.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,284.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,249.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,222.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,120.50
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
|
OP
|
$3,421.37
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$2,908.16 |
| Rate for Payer: Adventist Health Commercial |
$684.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$42.14
|
| Rate for Payer: Cash Price |
$1,539.62
|
| Rate for Payer: Cash Price |
$1,539.62
|
| Rate for Payer: Cigna of CA HMO |
$2,394.96
|
| Rate for Payer: Cigna of CA PPO |
$2,394.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,394.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.49
|
| Rate for Payer: EPIC Health Plan Senior |
$40.33
|
| Rate for Payer: Galaxy Health WC |
$2,908.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$60.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,172.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.12
|
| Rate for Payer: Multiplan Commercial |
$2,737.10
|
| Rate for Payer: Networks By Design Commercial |
$1,710.68
|
| Rate for Payer: Prime Health Services Commercial |
$2,908.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,052.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,052.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,284.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,249.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,222.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,120.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Vantage Medical Group Senior |
$40.33
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
|
IP
|
$5,132.04
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,026.41 |
| Max. Negotiated Rate |
$4,362.23 |
| Rate for Payer: Cigna of CA HMO |
$3,592.43
|
| Rate for Payer: Cigna of CA PPO |
$3,592.43
|
| Rate for Payer: Adventist Health Commercial |
$1,026.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,601.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3,946.54
|
| Rate for Payer: Cash Price |
$2,309.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,592.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,052.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2,052.82
|
| Rate for Payer: Galaxy Health WC |
$4,362.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,258.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,027.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.69
|
| Rate for Payer: Multiplan Commercial |
$4,105.63
|
| Rate for Payer: Networks By Design Commercial |
$2,566.02
|
| Rate for Payer: Prime Health Services Commercial |
$4,362.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1,874.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,680.74
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
|
OP
|
$5,132.04
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$4,362.23 |
| Rate for Payer: Adventist Health Commercial |
$1,026.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$42.14
|
| Rate for Payer: Cash Price |
$2,309.42
|
| Rate for Payer: Cash Price |
$2,309.42
|
| Rate for Payer: Cigna of CA HMO |
$3,592.43
|
| Rate for Payer: Cigna of CA PPO |
$3,592.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,592.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.49
|
| Rate for Payer: EPIC Health Plan Senior |
$40.33
|
| Rate for Payer: Galaxy Health WC |
$4,362.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3,079.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$60.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,258.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.12
|
| Rate for Payer: Multiplan Commercial |
$4,105.63
|
| Rate for Payer: Networks By Design Commercial |
$2,566.02
|
| Rate for Payer: Prime Health Services Commercial |
$4,362.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,079.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,079.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,926.05
|
| Rate for Payer: United Healthcare All Other HMO |
$1,874.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,680.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Vantage Medical Group Senior |
$40.33
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.83
|
| Rate for Payer: Cigna of CA PPO |
$7.83
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.47
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$9.50
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.59
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
|
OP
|
$11.18
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.83
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.47
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
|
IP
|
$12.62
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.73 |
| Rate for Payer: United Healthcare HMO Rider |
$9.65
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.70
|
| Rate for Payer: Blue Shield of California Commercial |
$20.76
|
| Rate for Payer: Blue Shield of California Commercial |
$13.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$8.83
|
| Rate for Payer: Cigna of CA PPO |
$8.83
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$10.73
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$6.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.73
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.13
|
| Rate for Payer: United Healthcare All Other HMO |
$9.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$8.83
|
| Rate for Payer: Cigna of CA PPO |
$8.83
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$10.73
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.31
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$10.73
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO |
$9.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare All Other HMO |
$4.61
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$10.73
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California Commercial |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$13.69
|
| Rate for Payer: Blue Shield of California Commercial |
$20.76
|
| Rate for Payer: Blue Shield of California Commercial |
$12.88
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.13
|
| Rate for Payer: United Healthcare All Other HMO |
$9.86
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare HMO Rider |
$9.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.84
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.90
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.13
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.86
|
| Rate for Payer: United Healthcare HMO Rider |
$9.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
|
IP
|
$12.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$19.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California Commercial |
$9.84
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| Rate for Payer: Blue Shield of California Commercial |
$15.09
|
| Rate for Payer: Blue Shield of California Commercial |
$13.01
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$10.26
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$10.88
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.68
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Prime Health Services Commercial |
$10.88
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare HMO Rider |
$9.17
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
|
OP
|
$25.66
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$10.88
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7.68
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.88
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.64
|
| Rate for Payer: United Healthcare HMO Rider |
$9.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10.88
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
|
IP
|
$11.08
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.42 |
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Blue Shield of California Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5.62
|
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5.68
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$7.84
|
| Rate for Payer: Cigna of CA HMO |
$7.76
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.84
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$9.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6.72
|
| Rate for Payer: Global Benefits Group Commercial |
$6.65
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.67
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
|
OP
|
$11.20
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA HMO |
$7.76
|
| Rate for Payer: Cigna of CA HMO |
$7.84
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.84
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.76
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.48
|
| Rate for Payer: EPIC Health Plan Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$9.42
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6.65
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$9.42
|
| Rate for Payer: Prime Health Services Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.42
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.42
|
| Rate for Payer: Vantage Medical Group Senior |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.75
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Blue Shield of California Commercial |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.73
|
| Rate for Payer: Cigna of CA HMO |
$6.55
|
| Rate for Payer: Cigna of CA PPO |
$6.55
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$7.73
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.96
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.83
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Networks By Design Commercial |
$5.52
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3.29
|
| Rate for Payer: United Healthcare All Other HMO |
$4.03
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Cigna of CA PPO |
$7.73
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$6.55
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$7.73
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$6.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$7.96
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$8.83
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.52
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Prime Health Services Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.29
|
| Rate for Payer: United Healthcare All Other HMO |
$3.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3.22
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7.96
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$9.38
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$5.37
|
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.45
|
| Rate for Payer: Blue Shield of California Commercial |
$8.26
|
| Rate for Payer: Blue Shield of California Commercial |
$22.92
|
| Rate for Payer: Blue Shield of California Commercial |
$15.11
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.18
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3.92
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$5.37
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$10.65
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$9.13
|
| Rate for Payer: Vantage Medical Group Senior |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
