|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$450.02 |
| 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 |
$317.66
|
| Rate for Payer: Blue Shield of California Commercial |
$390.20
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$238.25
|
| 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: 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 |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$397.08
|
| 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 |
$353.14
|
| 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 |
$127.07
|
| 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 |
$423.55
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.72
|
| Rate for Payer: United Healthcare HMO Rider |
$264.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.72
|
| 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 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
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 |
$31.76
|
| Rate for Payer: Blue Shield of California Commercial |
$39.02
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| 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 |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.70
|
| 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 |
$35.31
|
| 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 |
$12.71
|
| 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 |
$42.35
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$26.47
|
| Rate for Payer: United Healthcare HMO Rider |
$26.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| 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 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Blue Shield of California Commercial |
$37.69
|
| Rate for Payer: Blue Shield of California EPN |
$27.11
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.18
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$42.35
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.99
|
| Rate for Payer: United Healthcare All Other HMO |
$19.52
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.47
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$59.02
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
NDC155307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$50.17 |
| Rate for Payer: Blue Shield of California Commercial |
$42.02
|
| Rate for Payer: Blue Shield of California EPN |
$30.22
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cigna of CA HMO |
$41.31
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.61
|
| Rate for Payer: Galaxy Health WC |
$50.17
|
| Rate for Payer: Global Benefits Group Commercial |
$35.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.22
|
| Rate for Payer: Networks By Design Commercial |
$29.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.29
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$53.40
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1771290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Blue Shield of California Commercial |
$38.02
|
| Rate for Payer: Blue Shield of California EPN |
$27.34
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.16
|
| Rate for Payer: United Healthcare All Other HMO |
$19.69
|
| Rate for Payer: United Healthcare HMO Rider |
$19.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.62
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$59.02
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
NDC155307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: Blue Distinction Transplant |
$35.41
|
| Rate for Payer: Blue Shield of California Commercial |
$43.50
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cigna of CA HMO |
$41.31
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.17
|
| Rate for Payer: Dignity Health Media |
$50.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.61
|
| Rate for Payer: Galaxy Health WC |
$50.17
|
| Rate for Payer: Global Benefits Group Commercial |
$35.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.22
|
| Rate for Payer: Networks By Design Commercial |
$29.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.51
|
| Rate for Payer: United Healthcare All Other HMO |
$29.51
|
| Rate for Payer: United Healthcare HMO Rider |
$29.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.17
|
| Rate for Payer: Vantage Medical Group Senior |
$50.17
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$53.40
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1771290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: Blue Distinction Transplant |
$32.04
|
| Rate for Payer: Blue Shield of California Commercial |
$39.36
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Media |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.70
|
| Rate for Payer: United Healthcare All Other HMO |
$26.70
|
| Rate for Payer: United Healthcare HMO Rider |
$26.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Blue Shield of California Commercial |
$15.97
|
| Rate for Payer: Blue Shield of California EPN |
$11.48
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.47
|
| Rate for Payer: United Healthcare All Other HMO |
$8.27
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.40
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: Blue Distinction Transplant |
$13.46
|
| Rate for Payer: Blue Shield of California Commercial |
$16.53
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Media |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other HMO |
$11.22
|
| Rate for Payer: United Healthcare HMO Rider |
$11.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: Blue Distinction Transplant |
$32.50
|
| Rate for Payer: Blue Shield of California Commercial |
$39.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Media |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.08
|
| Rate for Payer: United Healthcare All Other HMO |
$27.08
|
| Rate for Payer: United Healthcare HMO Rider |
$27.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Blue Shield of California Commercial |
$38.57
|
| Rate for Payer: Blue Shield of California EPN |
$27.74
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.45
|
| Rate for Payer: United Healthcare All Other HMO |
$19.98
|
| Rate for Payer: United Healthcare HMO Rider |
$19.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
CPT J1327
|
| Hospital Charge Code |
1722021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J1327
|
| Hospital Charge Code |
1722021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$271.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.33
|
| Rate for Payer: Blue Distinction Transplant |
$1.80
|
| Rate for Payer: Blue Distinction Transplant |
$0.72
|
| Rate for Payer: Blue Distinction Transplant |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$11.28
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1722020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$4.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1722020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Blue Distinction Transplant |
$3.24
|
| Rate for Payer: Blue Distinction Transplant |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Media |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
CPT J0122
|
| Hospital Charge Code |
ERX222798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Blue Shield of California Commercial |
$48.70
|
| Rate for Payer: Blue Shield of California EPN |
$35.02
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.83
|
| Rate for Payer: United Healthcare All Other HMO |
$25.23
|
| Rate for Payer: United Healthcare HMO Rider |
$24.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.57
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
OP
|
$68.40
|
|
|
Service Code
|
CPT J0122
|
| Hospital Charge Code |
ERX222798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Blue Distinction Transplant |
$41.04
|
| Rate for Payer: Blue Shield of California Commercial |
$50.41
|
| Rate for Payer: Blue Shield of California EPN |
$39.95
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: Dignity Health Media |
$1.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.20
|
| Rate for Payer: United Healthcare All Other HMO |
$34.20
|
| Rate for Payer: United Healthcare HMO Rider |
$34.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
IP
|
$403.73
|
|
|
Service Code
|
NDC 59676-030-56
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$343.17 |
| Rate for Payer: Blue Shield of California Commercial |
$287.46
|
| Rate for Payer: Blue Shield of California EPN |
$206.71
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Cigna of CA HMO |
$282.61
|
| Rate for Payer: Cigna of CA PPO |
$282.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.49
|
| Rate for Payer: Galaxy Health WC |
$343.17
|
| Rate for Payer: Global Benefits Group Commercial |
$242.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.90
|
| Rate for Payer: Multiplan Commercial |
$322.98
|
| Rate for Payer: Networks By Design Commercial |
$201.86
|
| Rate for Payer: Prime Health Services Commercial |
$343.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.45
|
| Rate for Payer: United Healthcare All Other HMO |
$148.90
|
| Rate for Payer: United Healthcare HMO Rider |
$145.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.23
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
OP
|
$403.73
|
|
|
Service Code
|
NDC 59676-030-56
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$343.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$264.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.54
|
| Rate for Payer: Blue Distinction Transplant |
$242.24
|
| Rate for Payer: Blue Shield of California Commercial |
$297.55
|
| Rate for Payer: Blue Shield of California EPN |
$235.78
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Cigna of CA HMO |
$282.61
|
| Rate for Payer: Cigna of CA PPO |
$282.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.17
|
| Rate for Payer: Dignity Health Media |
$343.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.49
|
| Rate for Payer: Galaxy Health WC |
$343.17
|
| Rate for Payer: Global Benefits Group Commercial |
$242.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$302.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.90
|
| Rate for Payer: Multiplan Commercial |
$322.98
|
| Rate for Payer: Networks By Design Commercial |
$201.86
|
| Rate for Payer: Prime Health Services Commercial |
$343.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.86
|
| Rate for Payer: United Healthcare All Other HMO |
$201.86
|
| Rate for Payer: United Healthcare HMO Rider |
$201.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.17
|
| Rate for Payer: Vantage Medical Group Senior |
$343.17
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
IP
|
$538.30
|
|
|
Service Code
|
NDC 59676-040-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$457.56 |
| Rate for Payer: Blue Shield of California Commercial |
$383.27
|
| Rate for Payer: Blue Shield of California EPN |
$275.61
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Cigna of CA HMO |
$376.81
|
| Rate for Payer: Cigna of CA PPO |
$376.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.32
|
| Rate for Payer: Galaxy Health WC |
$457.56
|
| Rate for Payer: Global Benefits Group Commercial |
$322.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.19
|
| Rate for Payer: Multiplan Commercial |
$430.64
|
| Rate for Payer: Networks By Design Commercial |
$269.15
|
| Rate for Payer: Prime Health Services Commercial |
$457.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.26
|
| Rate for Payer: United Healthcare All Other HMO |
$198.53
|
| Rate for Payer: United Healthcare HMO Rider |
$194.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.64
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
OP
|
$538.30
|
|
|
Service Code
|
NDC 59676-040-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$457.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$353.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$296.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$296.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.72
|
| Rate for Payer: Blue Distinction Transplant |
$322.98
|
| Rate for Payer: Blue Shield of California Commercial |
$396.73
|
| Rate for Payer: Blue Shield of California EPN |
$314.37
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Cigna of CA HMO |
$376.81
|
| Rate for Payer: Cigna of CA PPO |
$376.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.56
|
| Rate for Payer: Dignity Health Media |
$457.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$457.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.32
|
| Rate for Payer: Galaxy Health WC |
$457.56
|
| Rate for Payer: Global Benefits Group Commercial |
$322.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$403.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.19
|
| Rate for Payer: Multiplan Commercial |
$430.64
|
| Rate for Payer: Networks By Design Commercial |
$269.15
|
| Rate for Payer: Prime Health Services Commercial |
$457.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.15
|
| Rate for Payer: United Healthcare All Other HMO |
$269.15
|
| Rate for Payer: United Healthcare HMO Rider |
$269.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$457.56
|
| Rate for Payer: Vantage Medical Group Senior |
$457.56
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
IP
|
$672.88
|
|
|
Service Code
|
NDC 59676-050-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$571.95 |
| Rate for Payer: Blue Shield of California Commercial |
$479.09
|
| Rate for Payer: Blue Shield of California EPN |
$344.51
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Cigna of CA HMO |
$471.02
|
| Rate for Payer: Cigna of CA PPO |
$471.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.15
|
| Rate for Payer: Galaxy Health WC |
$571.95
|
| Rate for Payer: Global Benefits Group Commercial |
$403.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.49
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Networks By Design Commercial |
$336.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.08
|
| Rate for Payer: United Healthcare All Other HMO |
$248.16
|
| Rate for Payer: United Healthcare HMO Rider |
$242.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.05
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
OP
|
$672.88
|
|
|
Service Code
|
NDC 59676-050-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$571.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$441.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$370.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$400.90
|
| Rate for Payer: Blue Distinction Transplant |
$403.73
|
| Rate for Payer: Blue Shield of California Commercial |
$495.91
|
| Rate for Payer: Blue Shield of California EPN |
$392.96
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Cigna of CA HMO |
$471.02
|
| Rate for Payer: Cigna of CA PPO |
$471.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.95
|
| Rate for Payer: Dignity Health Media |
$571.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$571.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.15
|
| Rate for Payer: Galaxy Health WC |
$571.95
|
| Rate for Payer: Global Benefits Group Commercial |
$403.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$504.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.49
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Networks By Design Commercial |
$336.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.44
|
| Rate for Payer: United Healthcare All Other HMO |
$336.44
|
| Rate for Payer: United Healthcare HMO Rider |
$336.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$571.95
|
| Rate for Payer: Vantage Medical Group Senior |
$571.95
|
|
