|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Blue Shield of California Commercial |
$100.87
|
| Rate for Payer: Blue Shield of California Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other HMO |
$234.30
|
| Rate for Payer: United Healthcare HMO Rider |
$229.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.28 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Blue Shield of California Commercial |
$325.19
|
| Rate for Payer: Blue Shield of California Commercial |
$493.24
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.56
|
| Rate for Payer: EPIC Health Plan Senior |
$256.56
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other HMO |
$234.30
|
| Rate for Payer: United Healthcare HMO Rider |
$229.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.06
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
OP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$54.53 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cigna of CA HMO |
$44.91
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.91
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.89
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other HMO |
$14.54
|
| Rate for Payer: United Healthcare All Other HMO |
$23.43
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
IP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$54.53 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$49.33
|
| Rate for Payer: Blue Shield of California Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cigna of CA HMO |
$44.91
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.66
|
| Rate for Payer: EPIC Health Plan Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Senior |
$25.66
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.89
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO |
$23.43
|
| Rate for Payer: United Healthcare All Other HMO |
$14.54
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.01
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$35.15
|
| Rate for Payer: United Healthcare HMO Rider |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$48.78
|
| Rate for Payer: Blue Shield of California Commercial |
$73.99
|
| Rate for Payer: Blue Shield of California Commercial |
$30.26
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.11
|
| Rate for Payer: United Healthcare All Other HMO |
$35.15
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.51
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
|
OP
|
$1,282.80
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$1,090.38 |
| Rate for Payer: Adventist Health Commercial |
$256.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$897.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$814.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$1,026.24
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.43
|
| Rate for Payer: United Healthcare All Other HMO |
$468.61
|
| Rate for Payer: United Healthcare HMO Rider |
$458.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
|
IP
|
$1,282.80
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.56 |
| Max. Negotiated Rate |
$1,090.38 |
| Rate for Payer: Adventist Health Commercial |
$256.56
|
| Rate for Payer: Blue Shield of California Commercial |
$650.38
|
| Rate for Payer: Blue Shield of California Commercial |
$986.47
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$897.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.12
|
| Rate for Payer: EPIC Health Plan Senior |
$513.12
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$814.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$756.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.87
|
| Rate for Payer: Multiplan Commercial |
$1,026.24
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.43
|
| Rate for Payer: United Healthcare All Other HMO |
$468.61
|
| Rate for Payer: United Healthcare HMO Rider |
$458.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.12
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Blue Shield of California Commercial |
$65.04
|
| Rate for Payer: Blue Shield of California Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.31
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.14
|
| Rate for Payer: United Healthcare All Other HMO |
$46.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.01
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.14
|
| Rate for Payer: United Healthcare All Other HMO |
$46.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$138.95
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$118.11 |
| Rate for Payer: Adventist Health Commercial |
$27.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cigna of CA HMO |
$97.27
|
| Rate for Payer: Cigna of CA PPO |
$97.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$118.11
|
| Rate for Payer: Global Benefits Group Commercial |
$83.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$111.16
|
| Rate for Payer: Networks By Design Commercial |
$69.47
|
| Rate for Payer: Prime Health Services Commercial |
$118.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.15
|
| Rate for Payer: United Healthcare All Other HMO |
$50.76
|
| Rate for Payer: United Healthcare HMO Rider |
$49.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$138.95
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$118.11 |
| Rate for Payer: Adventist Health Commercial |
$27.79
|
| Rate for Payer: Blue Shield of California Commercial |
$106.85
|
| Rate for Payer: Blue Shield of California Commercial |
$70.45
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cigna of CA HMO |
$97.27
|
| Rate for Payer: Cigna of CA PPO |
$97.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.58
|
| Rate for Payer: EPIC Health Plan Senior |
$55.58
|
| Rate for Payer: Galaxy Health WC |
$118.11
|
| Rate for Payer: Global Benefits Group Commercial |
$83.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.35
|
| Rate for Payer: Multiplan Commercial |
$111.16
|
| Rate for Payer: Networks By Design Commercial |
$69.47
|
| Rate for Payer: Prime Health Services Commercial |
$118.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.15
|
| Rate for Payer: United Healthcare All Other HMO |
$50.76
|
| Rate for Payer: United Healthcare HMO Rider |
$49.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.51
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$277.90
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$236.22 |
| Rate for Payer: Adventist Health Commercial |
$55.58
|
| Rate for Payer: Blue Shield of California Commercial |
$140.90
|
| Rate for Payer: Blue Shield of California Commercial |
$213.71
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cigna of CA HMO |
$194.53
|
| Rate for Payer: Cigna of CA PPO |
$194.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.16
|
| Rate for Payer: EPIC Health Plan Senior |
$111.16
|
| Rate for Payer: Galaxy Health WC |
$236.22
|
| Rate for Payer: Global Benefits Group Commercial |
$166.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.70
|
| Rate for Payer: Multiplan Commercial |
$222.32
|
| Rate for Payer: Networks By Design Commercial |
$138.95
|
| Rate for Payer: Prime Health Services Commercial |
$236.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.30
|
| Rate for Payer: United Healthcare All Other HMO |
$101.52
|
| Rate for Payer: United Healthcare HMO Rider |
$99.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.01
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$277.90
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$236.22 |
| Rate for Payer: Adventist Health Commercial |
$55.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cigna of CA HMO |
$194.53
|
| Rate for Payer: Cigna of CA PPO |
$194.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$236.22
|
| Rate for Payer: Global Benefits Group Commercial |
$166.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$222.32
|
| Rate for Payer: Networks By Design Commercial |
$138.95
|
| Rate for Payer: Prime Health Services Commercial |
$236.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.30
|
| Rate for Payer: United Healthcare All Other HMO |
$101.52
|
| Rate for Payer: United Healthcare HMO Rider |
$99.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$27.79
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$44.46 |
| Rate for Payer: Adventist Health Commercial |
$5.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cigna of CA HMO |
$19.45
|
| Rate for Payer: Cigna of CA PPO |
$19.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$23.62
|
| Rate for Payer: Global Benefits Group Commercial |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$22.23
|
| Rate for Payer: Networks By Design Commercial |
$13.89
|
| Rate for Payer: Prime Health Services Commercial |
$23.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$27.79
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Adventist Health Commercial |
$5.56
|
| Rate for Payer: Blue Shield of California Commercial |
$14.09
|
| Rate for Payer: Blue Shield of California Commercial |
$21.37
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cigna of CA HMO |
$19.45
|
| Rate for Payer: Cigna of CA PPO |
$19.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.12
|
| Rate for Payer: EPIC Health Plan Senior |
$11.12
|
| Rate for Payer: Galaxy Health WC |
$23.62
|
| Rate for Payer: Global Benefits Group Commercial |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.67
|
| Rate for Payer: Multiplan Commercial |
$22.23
|
| Rate for Payer: Networks By Design Commercial |
$13.89
|
| Rate for Payer: Prime Health Services Commercial |
$23.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
OP
|
$41.69
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$44.46 |
| Rate for Payer: Adventist Health Commercial |
$8.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cigna of CA HMO |
$29.18
|
| Rate for Payer: Cigna of CA PPO |
$29.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$35.44
|
| Rate for Payer: Global Benefits Group Commercial |
$25.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$33.35
|
| Rate for Payer: Networks By Design Commercial |
$20.84
|
| Rate for Payer: Prime Health Services Commercial |
$35.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.65
|
| Rate for Payer: United Healthcare All Other HMO |
$15.23
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
IP
|
$41.69
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Adventist Health Commercial |
$8.34
|
| Rate for Payer: Blue Shield of California Commercial |
$21.14
|
| Rate for Payer: Blue Shield of California Commercial |
$32.06
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cigna of CA HMO |
$29.18
|
| Rate for Payer: Cigna of CA PPO |
$29.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.68
|
| Rate for Payer: EPIC Health Plan Senior |
$16.68
|
| Rate for Payer: Galaxy Health WC |
$35.44
|
| Rate for Payer: Global Benefits Group Commercial |
$25.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.01
|
| Rate for Payer: Multiplan Commercial |
$33.35
|
| Rate for Payer: Networks By Design Commercial |
$20.84
|
| Rate for Payer: Prime Health Services Commercial |
$35.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.65
|
| Rate for Payer: United Healthcare All Other HMO |
$15.23
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
IP
|
$555.81
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.16 |
| Max. Negotiated Rate |
$472.44 |
| Rate for Payer: Adventist Health Commercial |
$111.16
|
| Rate for Payer: Blue Shield of California Commercial |
$281.80
|
| Rate for Payer: Blue Shield of California Commercial |
$427.42
|
| Rate for Payer: Cash Price |
$250.11
|
| Rate for Payer: Cigna of CA HMO |
$389.07
|
| Rate for Payer: Cigna of CA PPO |
$389.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.32
|
| Rate for Payer: EPIC Health Plan Senior |
$222.32
|
| Rate for Payer: Galaxy Health WC |
$472.44
|
| Rate for Payer: Global Benefits Group Commercial |
$333.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.39
|
| Rate for Payer: Multiplan Commercial |
$444.65
|
| Rate for Payer: Networks By Design Commercial |
$277.90
|
| Rate for Payer: Prime Health Services Commercial |
$472.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.60
|
| Rate for Payer: United Healthcare All Other HMO |
$203.04
|
| Rate for Payer: United Healthcare HMO Rider |
$198.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.03
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
OP
|
$555.81
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$472.44 |
| Rate for Payer: Adventist Health Commercial |
$111.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$250.11
|
| Rate for Payer: Cash Price |
$250.11
|
| Rate for Payer: Cigna of CA HMO |
$389.07
|
| Rate for Payer: Cigna of CA PPO |
$389.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$472.44
|
| Rate for Payer: Global Benefits Group Commercial |
$333.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$444.65
|
| Rate for Payer: Networks By Design Commercial |
$277.90
|
| Rate for Payer: Prime Health Services Commercial |
$472.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.60
|
| Rate for Payer: United Healthcare All Other HMO |
$203.04
|
| Rate for Payer: United Healthcare HMO Rider |
$198.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
IP
|
$55.58
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California Commercial |
$28.18
|
| Rate for Payer: Blue Shield of California Commercial |
$42.74
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$38.91
|
| Rate for Payer: Cigna of CA PPO |
$38.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.23
|
| Rate for Payer: EPIC Health Plan Senior |
$22.23
|
| Rate for Payer: Galaxy Health WC |
$47.24
|
| Rate for Payer: Global Benefits Group Commercial |
$33.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.34
|
| Rate for Payer: Multiplan Commercial |
$44.46
|
| Rate for Payer: Networks By Design Commercial |
$27.79
|
| Rate for Payer: Prime Health Services Commercial |
$47.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO |
$20.30
|
| Rate for Payer: United Healthcare HMO Rider |
$19.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.20
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
OP
|
$55.58
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$11.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cigna of CA HMO |
$38.91
|
| Rate for Payer: Cigna of CA PPO |
$38.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$47.24
|
| Rate for Payer: Global Benefits Group Commercial |
$33.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$44.46
|
| Rate for Payer: Networks By Design Commercial |
$27.79
|
| Rate for Payer: Prime Health Services Commercial |
$47.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO |
$20.30
|
| Rate for Payer: United Healthcare HMO Rider |
$19.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$70.30
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$101.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.13
|
| Rate for Payer: Adventist Health Commercial |
$14.06
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.57
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cigna of CA HMO |
$49.21
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$49.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$28.12
|
| Rate for Payer: EPIC Health Plan Senior |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$59.76
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$42.18
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.38
|
| Rate for Payer: Multiplan Commercial |
$56.24
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$35.15
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: Prime Health Services Commercial |
$59.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.38
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$25.68
|
| Rate for Payer: United Healthcare HMO Rider |
$25.13
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.76
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
| Rate for Payer: Vantage Medical Group Senior |
$59.76
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$59.76 |
| Rate for Payer: Adventist Health Commercial |
$14.06
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$41.06
|
| Rate for Payer: Blue Shield of California Commercial |
$35.64
|
| Rate for Payer: Blue Shield of California Commercial |
$54.06
|
| Rate for Payer: Blue Shield of California Commercial |
$27.07
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: Cigna of CA HMO |
$49.21
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$49.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.12
|
| Rate for Payer: EPIC Health Plan Senior |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$28.12
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Galaxy Health WC |
$59.76
|
| Rate for Payer: Global Benefits Group Commercial |
$42.18
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$56.24
|
| Rate for Payer: Networks By Design Commercial |
$35.15
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$59.76
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.02
|
|
