|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
|
IP
|
$35.77
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Shield of California Commercial |
$25.47
|
| Rate for Payer: Blue Shield of California Commercial |
$31.84
|
| Rate for Payer: Blue Shield of California Commercial |
$19.22
|
| Rate for Payer: Blue Shield of California Commercial |
$27.38
|
| Rate for Payer: Blue Shield of California EPN |
$22.90
|
| Rate for Payer: Blue Shield of California EPN |
$18.31
|
| Rate for Payer: Blue Shield of California EPN |
$19.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cigna of CA HMO |
$25.04
|
| Rate for Payer: Cigna of CA HMO |
$26.92
|
| Rate for Payer: Cigna of CA HMO |
$31.30
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$31.30
|
| Rate for Payer: Cigna of CA PPO |
$26.92
|
| Rate for Payer: Cigna of CA PPO |
$25.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Galaxy Health WC |
$38.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$21.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Global Benefits Group Commercial |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Multiplan Commercial |
$35.78
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$22.36
|
| Rate for Payer: Networks By Design Commercial |
$17.88
|
| Rate for Payer: Networks By Design Commercial |
$19.23
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Prime Health Services Commercial |
$30.40
|
| Rate for Payer: Prime Health Services Commercial |
$38.01
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO |
$14.18
|
| Rate for Payer: United Healthcare All Other HMO |
$16.49
|
| Rate for Payer: United Healthcare All Other HMO |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO |
$9.96
|
| Rate for Payer: United Healthcare HMO Rider |
$13.88
|
| Rate for Payer: United Healthcare HMO Rider |
$12.91
|
| Rate for Payer: United Healthcare HMO Rider |
$16.13
|
| Rate for Payer: United Healthcare HMO Rider |
$9.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.80
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
|
OP
|
$44.72
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$38.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Blue Distinction Transplant |
$21.46
|
| Rate for Payer: Blue Distinction Transplant |
$16.20
|
| Rate for Payer: Blue Distinction Transplant |
$26.83
|
| Rate for Payer: Blue Distinction Transplant |
$23.08
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California Commercial |
$26.36
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$32.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cigna of CA HMO |
$26.92
|
| Rate for Payer: Cigna of CA HMO |
$25.04
|
| Rate for Payer: Cigna of CA HMO |
$31.30
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$31.30
|
| Rate for Payer: Cigna of CA PPO |
$26.92
|
| Rate for Payer: Cigna of CA PPO |
$25.04
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.01
|
| Rate for Payer: Dignity Health Media |
$38.01
|
| Rate for Payer: Dignity Health Media |
$22.95
|
| Rate for Payer: Dignity Health Media |
$30.40
|
| Rate for Payer: Dignity Health Media |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$38.01
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Galaxy Health WC |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Global Benefits Group Commercial |
$26.83
|
| Rate for Payer: Global Benefits Group Commercial |
$21.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$35.78
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Multiplan Commercial |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$19.23
|
| Rate for Payer: Networks By Design Commercial |
$17.88
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$22.36
|
| Rate for Payer: Prime Health Services Commercial |
$38.01
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Prime Health Services Commercial |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.23
|
| Rate for Payer: United Healthcare All Other HMO |
$22.36
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$22.36
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$19.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.01
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$38.01
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$30.40
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1753497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California Commercial |
$18.27
|
| Rate for Payer: Blue Shield of California EPN |
$15.24
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Blue Shield of California EPN |
$6.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.88
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Other HMO |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$6.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1753497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Distinction Transplant |
$7.68
|
| Rate for Payer: Blue Distinction Transplant |
$17.86
|
| Rate for Payer: Blue Distinction Transplant |
$15.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18.91
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.43
|
| Rate for Payer: Blue Shield of California Commercial |
$21.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$8.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Media |
$25.30
|
| Rate for Payer: Dignity Health Media |
$10.88
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$21.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.88
|
| Rate for Payer: Global Benefits Group Commercial |
$7.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.88
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.40
|
| Rate for Payer: United Healthcare All Other HMO |
$12.83
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$6.40
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10.88
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.27
|
| Rate for Payer: Blue Shield of California EPN |
$12.23
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$15.24
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$16.72
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$16.72
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.94
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$20.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO |
$8.81
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9.88
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$9.67
|
| Rate for Payer: United Healthcare HMO Rider |
$8.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.49
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.47
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
|
OP
|
$23.88
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Blue Distinction Transplant |
$15.40
|
| Rate for Payer: Blue Distinction Transplant |
$14.33
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Distinction Transplant |
$17.86
|
| Rate for Payer: Blue Distinction Transplant |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$21.94
|
| Rate for Payer: Blue Shield of California Commercial |
$18.91
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California Commercial |
$17.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$16.72
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$16.72
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$22.77
|
| Rate for Payer: Dignity Health Media |
$25.30
|
| Rate for Payer: Dignity Health Media |
$20.30
|
| Rate for Payer: Dignity Health Media |
$21.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$11.94
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$20.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.94
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$12.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$20.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
|
IP
|
$12.27
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$10.43 |
| Rate for Payer: Blue Shield of California Commercial |
$8.74
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.28
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.59
|
| Rate for Payer: Cigna of CA PPO |
$8.59
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Global Benefits Group Commercial |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.14
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Prime Health Services Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.88
|
| Rate for Payer: United Healthcare HMO Rider |
$9.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.43
|
| Rate for Payer: United Healthcare HMO Rider |
$6.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.84
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
|
OP
|
$12.27
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Blue Distinction Transplant |
$16.07
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Distinction Transplant |
$7.36
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$8.59
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$8.59
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$10.43
|
| Rate for Payer: Dignity Health Media |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Galaxy Health WC |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Multiplan Commercial |
$9.82
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$6.14
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.14
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10.43
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Blue Distinction Transplant |
$17.88
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.33
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Media |
$25.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$21.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$15.26
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.99
|
| Rate for Payer: United Healthcare HMO Rider |
$10.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.33
|
| Rate for Payer: United Healthcare HMO Rider |
$6.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.83
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$19.10
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$13.73
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$18.77
|
| Rate for Payer: Cigna of CA PPO |
$18.77
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.73
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.13
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$9.89
|
| Rate for Payer: United Healthcare HMO Rider |
$6.49
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.85
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Distinction Transplant |
$16.09
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$19.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$18.77
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$18.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Media |
$22.80
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.73
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.41
|
| Rate for Payer: United Healthcare All Other HMO |
$13.41
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.80
|
| Rate for Payer: Vantage Medical Group Senior |
$22.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-11
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: Blue Distinction Transplant |
$2.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Media |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-11
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-21
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-21
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: Blue Distinction Transplant |
$2.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Media |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
1715226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.27
|
| Rate for Payer: Blue Distinction Transplant |
$3.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.67
|
| Rate for Payer: Dignity Health Media |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Vantage Medical Group Senior |
$4.67
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
1715226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 69097-426-02
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: Blue Distinction Transplant |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Media |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 69097-426-02
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$3.14
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$3.14
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.87
|
| Rate for Payer: Blue Distinction Transplant |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Media |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.95
|
| Rate for Payer: Blue Distinction Transplant |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Media |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
OP
|
$254.51
|
|
|
Service Code
|
NDC 50242-091-30
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$216.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.64
|
| Rate for Payer: Blue Distinction Transplant |
$152.71
|
| Rate for Payer: Blue Shield of California Commercial |
$187.57
|
| Rate for Payer: Blue Shield of California EPN |
$148.63
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.33
|
| Rate for Payer: Dignity Health Media |
$216.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$190.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.08
|
| Rate for Payer: Multiplan Commercial |
$203.61
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.26
|
| Rate for Payer: United Healthcare All Other HMO |
$127.26
|
| Rate for Payer: United Healthcare HMO Rider |
$127.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.33
|
| Rate for Payer: Vantage Medical Group Senior |
$216.33
|
|
