|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 43547-546-10
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
IP
|
$0.67
|
|
|
Service Code
|
NDC 68682-711-01
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
OP
|
$0.57
|
|
|
Service Code
|
NDC 0904-5502-61
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: BCBS Transplant Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
OP
|
$0.67
|
|
|
Service Code
|
NDC 68682-711-01
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: BCBS Transplant Transplant |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.47
|
| Rate for Payer: Cigna of CA PPO |
$0.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.57
|
| Rate for Payer: Dignity Health Media |
$0.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.27
|
| Rate for Payer: Galaxy Health WC |
$0.57
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.34
|
| Rate for Payer: United Healthcare HMO Rider |
$0.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Vantage Medical Group Senior |
$0.57
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 43547-546-10
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
IP
|
$0.57
|
|
|
Service Code
|
NDC 0904-5502-61
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.40
|
| Rate for Payer: Cigna of CA PPO |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
IP
|
$3,181.20
|
|
|
Service Code
|
NDC 51144-020-01
|
| Hospital Charge Code |
ERX226724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$763.49 |
| Max. Negotiated Rate |
$2,704.02 |
| Rate for Payer: Blue Shield of California Commercial |
$2,265.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,628.77
|
| Rate for Payer: Cash Price |
$1,431.54
|
| Rate for Payer: Cigna of CA HMO |
$2,226.84
|
| Rate for Payer: Cigna of CA PPO |
$2,226.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,272.48
|
| Rate for Payer: Galaxy Health WC |
$2,704.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.49
|
| Rate for Payer: Multiplan Commercial |
$2,544.96
|
| Rate for Payer: Networks By Design Commercial |
$1,590.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,704.02
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
OP
|
$3,181.20
|
|
|
Service Code
|
NDC 51144-020-01
|
| Hospital Charge Code |
ERX226724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$763.49 |
| Max. Negotiated Rate |
$2,704.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,086.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,704.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,749.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,749.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,895.36
|
| Rate for Payer: BCBS Transplant Transplant |
$1,908.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,344.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,857.82
|
| Rate for Payer: Cash Price |
$1,431.54
|
| Rate for Payer: Cash Price |
$1,431.54
|
| Rate for Payer: Cigna of CA HMO |
$2,226.84
|
| Rate for Payer: Cigna of CA PPO |
$2,226.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,704.02
|
| Rate for Payer: Dignity Health Media |
$2,704.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,704.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,272.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,272.48
|
| Rate for Payer: Galaxy Health WC |
$2,704.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1,908.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,385.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.49
|
| Rate for Payer: Multiplan Commercial |
$2,544.96
|
| Rate for Payer: Networks By Design Commercial |
$1,590.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,704.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,908.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,908.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,590.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,590.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,590.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,590.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,704.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,704.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2,704.02
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
IP
|
$4,771.80
|
|
|
Service Code
|
NDC 51144-030-01
|
| Hospital Charge Code |
ERX226725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,145.23 |
| Max. Negotiated Rate |
$4,056.03 |
| Rate for Payer: Blue Shield of California Commercial |
$3,397.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,443.16
|
| Rate for Payer: Cash Price |
$2,147.31
|
| Rate for Payer: Cigna of CA HMO |
$3,340.26
|
| Rate for Payer: Cigna of CA PPO |
$3,340.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,908.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,908.72
|
| Rate for Payer: Galaxy Health WC |
$4,056.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2,863.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,818.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.23
|
| Rate for Payer: Multiplan Commercial |
$3,817.44
|
| Rate for Payer: Networks By Design Commercial |
$2,385.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,056.03
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
OP
|
$4,771.80
|
|
|
Service Code
|
NDC 51144-030-01
|
| Hospital Charge Code |
ERX226725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,145.23 |
| Max. Negotiated Rate |
$4,056.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,129.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,056.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,624.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,624.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,843.04
|
| Rate for Payer: BCBS Transplant Transplant |
$2,863.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,516.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,786.73
|
| Rate for Payer: Cash Price |
$2,147.31
|
| Rate for Payer: Cash Price |
$2,147.31
|
| Rate for Payer: Cigna of CA HMO |
$3,340.26
|
| Rate for Payer: Cigna of CA PPO |
$3,340.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,056.03
|
| Rate for Payer: Dignity Health Media |
$4,056.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,056.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,908.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,908.72
|
| Rate for Payer: Galaxy Health WC |
$4,056.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2,863.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,578.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,818.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.23
|
| Rate for Payer: Multiplan Commercial |
$3,817.44
|
| Rate for Payer: Networks By Design Commercial |
$2,385.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,056.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,863.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,863.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,385.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,385.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2,385.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,385.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,056.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,056.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,056.03
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
IP
|
$11.18
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: EPIC Health Plan Commercial |
$4.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.47
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$5.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$7.83
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.71
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$5.59
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.50
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
OP
|
$11.18
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$6.71
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.24
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$7.83
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$7.83
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.50
|
| Rate for Payer: Dignity Health Media |
$9.50
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.47
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$9.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.68
|
| Rate for Payer: Multiplan Commercial |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$5.59
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$8.83
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$8.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$16.20
|
| Rate for Payer: BCBS Transplant Transplant |
$7.57
|
| Rate for Payer: Blue Shield of California Commercial |
$9.30
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Media |
$10.73
|
| Rate for Payer: Dignity Health Media |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$10.73
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$6.31
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Prime Health Services Commercial |
$10.73
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$10.73
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
IP
|
$12.62
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$10.73 |
| Rate for Payer: Blue Shield of California Commercial |
$8.99
|
| Rate for Payer: Blue Shield of California Commercial |
$19.22
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.46
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$8.83
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$8.83
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.73
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.57
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$6.31
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$10.73
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
OP
|
$38.46
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$32.69 |
| Rate for Payer: Dignity Health Media |
$38.01
|
| Rate for Payer: Dignity Health Media |
$30.40
|
| Rate for Payer: Dignity Health Media |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.89
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Galaxy Health WC |
$38.01
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$21.46
|
| Rate for Payer: BCBS Transplant Transplant |
$23.08
|
| Rate for Payer: BCBS Transplant Transplant |
$26.83
|
| Rate for Payer: BCBS Transplant Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California Commercial |
$26.36
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$32.96
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$31.30
|
| Rate for Payer: Cigna of CA HMO |
$25.04
|
| Rate for Payer: Cigna of CA HMO |
$26.92
|
| Rate for Payer: Cigna of CA PPO |
$25.04
|
| Rate for Payer: Cigna of CA PPO |
$31.30
|
| Rate for Payer: Cigna of CA PPO |
$26.92
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Media |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.46
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$35.78
|
| Rate for Payer: Multiplan Commercial |
$28.62
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Networks By Design Commercial |
$22.36
|
| Rate for Payer: Networks By Design Commercial |
$19.23
|
| Rate for Payer: Networks By Design Commercial |
$17.88
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.40
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Prime Health Services Commercial |
$38.01
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.36
|
| Rate for Payer: United Healthcare All Other HMO |
$19.23
|
| Rate for Payer: United Healthcare HMO Rider |
$19.23
|
| Rate for Payer: United Healthcare HMO Rider |
$22.36
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.01
|
| Rate for Payer: Vantage Medical Group Senior |
$38.01
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.40
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
IP
|
$44.72
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$38.01 |
| Rate for Payer: Blue Shield of California Commercial |
$31.84
|
| Rate for Payer: Blue Shield of California Commercial |
$19.22
|
| Rate for Payer: Blue Shield of California Commercial |
$25.47
|
| Rate for Payer: Blue Shield of California Commercial |
$27.38
|
| Rate for Payer: Blue Shield of California EPN |
$18.31
|
| Rate for Payer: Blue Shield of California EPN |
$22.90
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Blue Shield of California EPN |
$19.69
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cigna of CA HMO |
$26.92
|
| Rate for Payer: Cigna of CA HMO |
$31.30
|
| Rate for Payer: Cigna of CA HMO |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$25.04
|
| Rate for Payer: Cigna of CA PPO |
$18.90
|
| Rate for Payer: Cigna of CA PPO |
$31.30
|
| Rate for Payer: Cigna of CA PPO |
$25.04
|
| Rate for Payer: Cigna of CA PPO |
$26.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$38.01
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Galaxy Health WC |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$26.83
|
| Rate for Payer: Global Benefits Group Commercial |
$21.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$35.78
|
| Rate for Payer: Multiplan Commercial |
$28.62
|
| Rate for Payer: Networks By Design Commercial |
$19.23
|
| Rate for Payer: Networks By Design Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$17.88
|
| Rate for Payer: Networks By Design Commercial |
$22.36
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$30.40
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Prime Health Services Commercial |
$38.01
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1753497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: BCBS Transplant Transplant |
$15.40
|
| Rate for Payer: BCBS Transplant Transplant |
$17.86
|
| Rate for Payer: BCBS Transplant Transplant |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$18.91
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$21.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Media |
$10.88
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$21.81
|
| Rate for Payer: Dignity Health Media |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.88
|
| Rate for Payer: Global Benefits Group Commercial |
$7.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.88
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$12.83
|
| Rate for Payer: United Healthcare All Other HMO |
$6.40
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.40
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$12.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10.88
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1753497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18.27
|
| Rate for Payer: Blue Shield of California Commercial |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$15.24
|
| Rate for Payer: Blue Shield of California EPN |
$6.55
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.88
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$10.24
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$10.88
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
IP
|
$25.66
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Blue Shield of California Commercial |
$18.27
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$21.20
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$12.23
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Blue Shield of California EPN |
$15.24
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$16.72
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$16.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14.33
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$11.94
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$20.30
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
OP
|
$29.77
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA HMO |
$16.72
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$20.84
|
| Rate for Payer: Cigna of CA HMO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$16.72
|
| Rate for Payer: Cigna of CA PPO |
$20.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$17.86
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: BCBS Transplant Transplant |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$15.40
|
| Rate for Payer: BCBS Transplant Transplant |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California Commercial |
$17.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18.91
|
| Rate for Payer: Blue Shield of California Commercial |
$21.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Media |
$20.30
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$22.77
|
| Rate for Payer: Dignity Health Media |
$21.81
|
| Rate for Payer: Dignity Health Media |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Galaxy Health WC |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$21.81
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Global Benefits Group Commercial |
$14.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$12.83
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$11.94
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.30
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$21.81
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$12.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.94
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.94
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$20.30
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
OP
|
$12.27
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.59
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$8.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: BCBS Transplant Transplant |
$7.36
|
| Rate for Payer: BCBS Transplant Transplant |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Media |
$10.43
|
| Rate for Payer: Dignity Health Media |
$22.77
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Global Benefits Group Commercial |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.14
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.14
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.14
|
| Rate for Payer: United Healthcare HMO Rider |
$6.14
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10.43
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [105900]
|
Facility
IP
|
$12.27
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$10.43 |
| Rate for Payer: Blue Shield of California Commercial |
$8.74
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.59
|
| Rate for Payer: Cigna of CA HMO |
$18.75
|
| Rate for Payer: Cigna of CA PPO |
$8.59
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Multiplan Commercial |
$9.82
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$6.14
|
| Rate for Payer: Networks By Design Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.43
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
IP
|
$29.80
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$25.33 |
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$21.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$15.26
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [105901]
|
Facility
OP
|
$29.80
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$17.88
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$20.86
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Media |
$25.33
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$25.33
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$23.84
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$14.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$25.33
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.33
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.33
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
OP
|
$26.82
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.67
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: BCBS Transplant Transplant |
$16.09
|
| Rate for Payer: Blue Shield of California Commercial |
$19.77
|
| Rate for Payer: Blue Shield of California Commercial |
$13.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$18.77
|
| Rate for Payer: Cigna of CA PPO |
$18.77
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Media |
$22.80
|
| Rate for Payer: Dignity Health Media |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.73
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.41
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.41
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$22.80
|
|
