|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| 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 |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Distinction Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| 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 Media |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| 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
|
| 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
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| 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: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| 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
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
OP
|
$320.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$192.41
|
| Rate for Payer: Blue Distinction Transplant |
$119.38
|
| Rate for Payer: Blue Distinction Transplant |
$192.42
|
| Rate for Payer: Blue Shield of California Commercial |
$146.63
|
| Rate for Payer: Blue Shield of California Commercial |
$236.35
|
| Rate for Payer: Blue Shield of California Commercial |
$236.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$240.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$149.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$240.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$160.35
|
| Rate for Payer: United Healthcare All Other HMO |
$160.34
|
| Rate for Payer: United Healthcare HMO Rider |
$99.48
|
| Rate for Payer: United Healthcare HMO Rider |
$160.35
|
| Rate for Payer: United Healthcare HMO Rider |
$160.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Blue Shield of California Commercial |
$141.66
|
| Rate for Payer: Blue Shield of California Commercial |
$228.33
|
| Rate for Payer: Blue Shield of California Commercial |
$228.34
|
| Rate for Payer: Blue Shield of California EPN |
$164.19
|
| Rate for Payer: Blue Shield of California EPN |
$164.20
|
| Rate for Payer: Blue Shield of California EPN |
$101.87
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.28
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.13
|
| Rate for Payer: United Healthcare All Other HMO |
$118.27
|
| Rate for Payer: United Healthcare All Other HMO |
$73.38
|
| Rate for Payer: United Healthcare All Other HMO |
$118.27
|
| Rate for Payer: United Healthcare HMO Rider |
$115.71
|
| Rate for Payer: United Healthcare HMO Rider |
$71.78
|
| Rate for Payer: United Healthcare HMO Rider |
$115.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.83
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Blue Shield of California Commercial |
$141.66
|
| Rate for Payer: Blue Shield of California EPN |
$101.87
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.13
|
| Rate for Payer: United Healthcare All Other HMO |
$73.38
|
| Rate for Payer: United Healthcare HMO Rider |
$71.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.66
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$119.38
|
| Rate for Payer: Blue Shield of California Commercial |
$146.63
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$149.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$99.48
|
| Rate for Payer: United Healthcare HMO Rider |
$99.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$384.84
|
| Rate for Payer: Blue Shield of California Commercial |
$472.71
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$481.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.70
|
| Rate for Payer: United Healthcare All Other HMO |
$320.70
|
| Rate for Payer: United Healthcare HMO Rider |
$320.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.94 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Blue Shield of California Commercial |
$456.68
|
| Rate for Payer: Blue Shield of California EPN |
$328.40
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$256.56
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.19
|
| Rate for Payer: United Healthcare All Other HMO |
$236.55
|
| Rate for Payer: United Healthcare HMO Rider |
$231.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.66
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
IP
|
$39.79
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Blue Shield of California Commercial |
$28.33
|
| Rate for Payer: Blue Shield of California Commercial |
$45.67
|
| Rate for Payer: Blue Shield of California EPN |
$20.37
|
| Rate for Payer: Blue Shield of California EPN |
$32.84
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA HMO |
$44.90
|
| Rate for Payer: Cigna of CA PPO |
$44.90
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.66
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$19.90
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.22
|
| Rate for Payer: United Healthcare All Other HMO |
$14.67
|
| Rate for Payer: United Healthcare All Other HMO |
$23.66
|
| Rate for Payer: United Healthcare HMO Rider |
$14.36
|
| Rate for Payer: United Healthcare HMO Rider |
$23.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.17
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
OP
|
$39.79
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$38.49
|
| Rate for Payer: Blue Distinction Transplant |
$23.87
|
| Rate for Payer: Blue Shield of California Commercial |
$47.28
|
| Rate for Payer: Blue Shield of California Commercial |
$29.33
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cigna of CA HMO |
$44.90
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$32.08
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
OP
|
$59.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$57.73
|
| Rate for Payer: Blue Distinction Transplant |
$35.81
|
| Rate for Payer: Blue Shield of California Commercial |
$70.91
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.84
|
| Rate for Payer: United Healthcare All Other HMO |
$29.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.11
|
| Rate for Payer: United Healthcare HMO Rider |
$29.84
|
| Rate for Payer: United Healthcare HMO Rider |
$48.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
IP
|
$59.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Blue Shield of California Commercial |
$42.50
|
| Rate for Payer: Blue Shield of California Commercial |
$68.51
|
| Rate for Payer: Blue Shield of California EPN |
$30.56
|
| Rate for Payer: Blue Shield of California EPN |
$49.26
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.33
|
| Rate for Payer: United Healthcare All Other HMO |
$22.01
|
| Rate for Payer: United Healthcare All Other HMO |
$35.49
|
| Rate for Payer: United Healthcare HMO Rider |
$21.54
|
| Rate for Payer: United Healthcare HMO Rider |
$34.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.75
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
|
OP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$1,090.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$769.68
|
| Rate for Payer: Blue Shield of California Commercial |
$945.42
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$1,026.24
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other HMO |
$641.40
|
| Rate for Payer: United Healthcare HMO Rider |
$641.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
|
IP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.87 |
| Max. Negotiated Rate |
$1,090.38 |
| Rate for Payer: Blue Shield of California Commercial |
$913.35
|
| Rate for Payer: Blue Shield of California EPN |
$656.79
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$513.12
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.87
|
| Rate for Payer: Multiplan Commercial |
$1,026.24
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.39
|
| Rate for Payer: United Healthcare All Other HMO |
$473.10
|
| Rate for Payer: United Healthcare HMO Rider |
$462.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.32
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Blue Shield of California Commercial |
$91.34
|
| Rate for Payer: Blue Shield of California EPN |
$65.68
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.44
|
| Rate for Payer: United Healthcare All Other HMO |
$47.31
|
| Rate for Payer: United Healthcare HMO Rider |
$46.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.33
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$76.97
|
| Rate for Payer: Blue Shield of California Commercial |
$94.54
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.14
|
| Rate for Payer: United Healthcare All Other HMO |
$64.14
|
| Rate for Payer: United Healthcare HMO Rider |
$64.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: Blue Distinction Transplant |
$79.42
|
| Rate for Payer: Blue Shield of California Commercial |
$97.55
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.18
|
| Rate for Payer: United Healthcare All Other HMO |
$66.18
|
| Rate for Payer: United Healthcare HMO Rider |
$66.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$67.77
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.94
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.98
|
| Rate for Payer: United Healthcare All Other HMO |
$48.81
|
| Rate for Payer: United Healthcare HMO Rider |
$47.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.68
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: Blue Distinction Transplant |
$158.83
|
| Rate for Payer: Blue Shield of California Commercial |
$195.10
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$211.78
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.36
|
| Rate for Payer: United Healthcare All Other HMO |
$132.36
|
| Rate for Payer: United Healthcare HMO Rider |
$132.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Blue Shield of California Commercial |
$188.48
|
| Rate for Payer: Blue Shield of California EPN |
$135.54
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.89
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.53
|
| Rate for Payer: Multiplan Commercial |
$211.78
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.96
|
| Rate for Payer: United Healthcare All Other HMO |
$97.63
|
| Rate for Payer: United Healthcare HMO Rider |
$95.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.36
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Blue Shield of California Commercial |
$18.85
|
| Rate for Payer: Blue Shield of California EPN |
$13.55
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.59
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$21.18
|
| Rate for Payer: Networks By Design Commercial |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.74
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$49.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: Blue Distinction Transplant |
$15.88
|
| Rate for Payer: Blue Shield of California Commercial |
$19.51
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$21.18
|
| Rate for Payer: Networks By Design Commercial |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Blue Shield of California Commercial |
$28.27
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$31.77
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$49.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: Blue Distinction Transplant |
$23.83
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$31.77
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.86
|
| Rate for Payer: United Healthcare All Other HMO |
$19.86
|
| Rate for Payer: United Healthcare HMO Rider |
$19.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
IP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.07 |
| Max. Negotiated Rate |
$450.02 |
| Rate for Payer: Blue Shield of California Commercial |
$376.96
|
| Rate for Payer: Blue Shield of California EPN |
$271.07
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.78
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.07
|
| Rate for Payer: Multiplan Commercial |
$423.55
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.92
|
| Rate for Payer: United Healthcare All Other HMO |
$195.26
|
| Rate for Payer: United Healthcare HMO Rider |
$191.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.72
|
|
