|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$101.13 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.57
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.70
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.42
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11.37
|
| Rate for Payer: Blue Shield of California Commercial |
$17.25
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.42
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.35
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California Commercial |
$27.46
|
| Rate for Payer: Blue Shield of California Commercial |
$41.66
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$19.79
|
| Rate for Payer: United Healthcare HMO Rider |
$19.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.74
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$101.13 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.57
|
| Rate for Payer: Blue Shield of California Commercial |
$22.43
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$19.79
|
| Rate for Payer: United Healthcare HMO Rider |
$19.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.19
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.19
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4.15
|
| Rate for Payer: Blue Shield of California Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
OP
|
$87.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$74.38 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cigna of CA HMO |
$61.25
|
| Rate for Payer: Cigna of CA PPO |
$61.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$74.38
|
| Rate for Payer: Global Benefits Group Commercial |
$52.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$70.00
|
| Rate for Payer: Networks By Design Commercial |
$43.75
|
| Rate for Payer: Prime Health Services Commercial |
$74.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.84
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.52
|
| Rate for Payer: Vantage Medical Group Senior |
$1.38
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
IP
|
$87.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$74.38 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Blue Shield of California Commercial |
$44.36
|
| Rate for Payer: Blue Shield of California Commercial |
$67.29
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cigna of CA HMO |
$61.25
|
| Rate for Payer: Cigna of CA PPO |
$61.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.00
|
| Rate for Payer: EPIC Health Plan Senior |
$35.00
|
| Rate for Payer: Galaxy Health WC |
$74.38
|
| Rate for Payer: Global Benefits Group Commercial |
$52.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$70.00
|
| Rate for Payer: Networks By Design Commercial |
$43.75
|
| Rate for Payer: Prime Health Services Commercial |
$74.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.84
|
| Rate for Payer: United Healthcare All Other HMO |
$31.96
|
| Rate for Payer: United Healthcare HMO Rider |
$31.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.66
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
OP
|
$466.66
|
|
|
Service Code
|
NDC 5967603056
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$93.33 |
| Max. Negotiated Rate |
$396.66 |
| Rate for Payer: Adventist Health Commercial |
$93.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$299.46
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna of CA HMO |
$326.66
|
| Rate for Payer: Cigna of CA PPO |
$326.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$326.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.66
|
| Rate for Payer: EPIC Health Plan Senior |
$186.66
|
| Rate for Payer: Galaxy Health WC |
$396.66
|
| Rate for Payer: Global Benefits Group Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$296.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$326.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$326.66
|
| Rate for Payer: Multiplan Commercial |
$373.33
|
| Rate for Payer: Networks By Design Commercial |
$303.33
|
| Rate for Payer: Prime Health Services Commercial |
$396.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.33
|
| Rate for Payer: United Healthcare All Other HMO |
$233.33
|
| Rate for Payer: United Healthcare HMO Rider |
$233.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.66
|
| Rate for Payer: Vantage Medical Group Senior |
$396.66
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
IP
|
$466.66
|
|
|
Service Code
|
NDC 5967603056
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$93.33 |
| Max. Negotiated Rate |
$396.66 |
| Rate for Payer: Adventist Health Commercial |
$93.33
|
| Rate for Payer: Blue Shield of California Commercial |
$236.60
|
| Rate for Payer: Blue Shield of California Commercial |
$358.86
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna of CA HMO |
$326.66
|
| Rate for Payer: Cigna of CA PPO |
$326.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$326.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.66
|
| Rate for Payer: EPIC Health Plan Senior |
$186.66
|
| Rate for Payer: Galaxy Health WC |
$396.66
|
| Rate for Payer: Global Benefits Group Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$296.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$373.33
|
| Rate for Payer: Networks By Design Commercial |
$303.33
|
| Rate for Payer: Prime Health Services Commercial |
$396.66
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
IP
|
$622.22
|
|
|
Service Code
|
NDC 5967604028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.44 |
| Max. Negotiated Rate |
$528.89 |
| Rate for Payer: Adventist Health Commercial |
$124.44
|
| Rate for Payer: Blue Shield of California Commercial |
$315.47
|
| Rate for Payer: Blue Shield of California Commercial |
$478.49
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$435.55
|
| Rate for Payer: Cigna of CA PPO |
$435.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.89
|
| Rate for Payer: EPIC Health Plan Senior |
$248.89
|
| Rate for Payer: Galaxy Health WC |
$528.89
|
| Rate for Payer: Global Benefits Group Commercial |
$373.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$395.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$367.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.33
|
| Rate for Payer: Multiplan Commercial |
$497.78
|
| Rate for Payer: Networks By Design Commercial |
$404.44
|
| Rate for Payer: Prime Health Services Commercial |
$528.89
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
OP
|
$622.22
|
|
|
Service Code
|
NDC 5967604028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.44 |
| Max. Negotiated Rate |
$528.89 |
| Rate for Payer: Adventist Health Commercial |
$124.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$408.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.28
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$435.55
|
| Rate for Payer: Cigna of CA PPO |
$435.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$435.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.89
|
| Rate for Payer: EPIC Health Plan Senior |
$248.89
|
| Rate for Payer: Galaxy Health WC |
$528.89
|
| Rate for Payer: Global Benefits Group Commercial |
$373.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$395.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$367.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.55
|
| Rate for Payer: Multiplan Commercial |
$497.78
|
| Rate for Payer: Networks By Design Commercial |
$404.44
|
| Rate for Payer: Prime Health Services Commercial |
$528.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$373.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.11
|
| Rate for Payer: United Healthcare All Other HMO |
$311.11
|
| Rate for Payer: United Healthcare HMO Rider |
$311.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.89
|
| Rate for Payer: Vantage Medical Group Senior |
$528.89
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
IP
|
$777.78
|
|
|
Service Code
|
NDC 5967605028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$155.56 |
| Max. Negotiated Rate |
$661.11 |
| Rate for Payer: Adventist Health Commercial |
$155.56
|
| Rate for Payer: Blue Shield of California Commercial |
$394.33
|
| Rate for Payer: Blue Shield of California Commercial |
$598.11
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$544.45
|
| Rate for Payer: Cigna of CA PPO |
$544.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.11
|
| Rate for Payer: EPIC Health Plan Senior |
$311.11
|
| Rate for Payer: Galaxy Health WC |
$661.11
|
| Rate for Payer: Global Benefits Group Commercial |
$466.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$493.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$458.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.67
|
| Rate for Payer: Multiplan Commercial |
$622.22
|
| Rate for Payer: Networks By Design Commercial |
$505.56
|
| Rate for Payer: Prime Health Services Commercial |
$661.11
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
OP
|
$777.78
|
|
|
Service Code
|
NDC 5967605028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$155.56 |
| Max. Negotiated Rate |
$661.11 |
| Rate for Payer: Adventist Health Commercial |
$155.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$427.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$583.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.10
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$544.45
|
| Rate for Payer: Cigna of CA PPO |
$544.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$661.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$661.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.11
|
| Rate for Payer: EPIC Health Plan Senior |
$311.11
|
| Rate for Payer: Galaxy Health WC |
$661.11
|
| Rate for Payer: Global Benefits Group Commercial |
$466.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$493.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$458.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$544.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$544.45
|
| Rate for Payer: Multiplan Commercial |
$622.22
|
| Rate for Payer: Networks By Design Commercial |
$505.56
|
| Rate for Payer: Prime Health Services Commercial |
$661.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.89
|
| Rate for Payer: United Healthcare All Other HMO |
$388.89
|
| Rate for Payer: United Healthcare HMO Rider |
$388.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$388.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.11
|
| Rate for Payer: Vantage Medical Group Senior |
$661.11
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
OP
|
$939.62
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.92 |
| Max. Negotiated Rate |
$798.68 |
| Rate for Payer: Adventist Health Commercial |
$187.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$616.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$798.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$516.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$704.72
|
| Rate for Payer: Cash Price |
$422.83
|
| Rate for Payer: Cigna of CA HMO |
$657.73
|
| Rate for Payer: Cigna of CA PPO |
$657.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$798.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$798.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.85
|
| Rate for Payer: EPIC Health Plan Senior |
$375.85
|
| Rate for Payer: Galaxy Health WC |
$798.68
|
| Rate for Payer: Global Benefits Group Commercial |
$563.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$657.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$657.73
|
| Rate for Payer: Multiplan Commercial |
$751.70
|
| Rate for Payer: Networks By Design Commercial |
$469.81
|
| Rate for Payer: Prime Health Services Commercial |
$798.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$563.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.64
|
| Rate for Payer: United Healthcare All Other HMO |
$343.24
|
| Rate for Payer: United Healthcare HMO Rider |
$335.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$798.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.68
|
| Rate for Payer: Vantage Medical Group Senior |
$798.68
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
IP
|
$939.62
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.92 |
| Max. Negotiated Rate |
$798.68 |
| Rate for Payer: Adventist Health Commercial |
$187.92
|
| Rate for Payer: Blue Shield of California Commercial |
$476.39
|
| Rate for Payer: Blue Shield of California Commercial |
$722.57
|
| Rate for Payer: Cash Price |
$422.83
|
| Rate for Payer: Cigna of CA HMO |
$657.73
|
| Rate for Payer: Cigna of CA PPO |
$657.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.85
|
| Rate for Payer: EPIC Health Plan Senior |
$375.85
|
| Rate for Payer: Galaxy Health WC |
$798.68
|
| Rate for Payer: Global Benefits Group Commercial |
$563.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.51
|
| Rate for Payer: Multiplan Commercial |
$751.70
|
| Rate for Payer: Networks By Design Commercial |
$469.81
|
| Rate for Payer: Prime Health Services Commercial |
$798.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.64
|
| Rate for Payer: United Healthcare All Other HMO |
$343.24
|
| Rate for Payer: United Healthcare HMO Rider |
$335.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.73
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 5026829711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 5026829715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6945215120
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 4280654701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 5026829715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
