|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1712561
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1712561
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
IP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Blue Shield of California Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.76
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
OP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: BCBS Transplant Transplant |
$7.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Media |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
IP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Blue Shield of California Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.76
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
OP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: BCBS Transplant Transplant |
$7.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Media |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION [88009]
|
Facility
OP
|
$2.32
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
NDG88009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$55.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.97
|
| Rate for Payer: Dignity Health Media |
$1.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.97
|
|
|
EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION [88009]
|
Facility
IP
|
$2.32
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
NDG88009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.19
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.86
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.97
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
OP
|
$2.24
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
1755705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$55.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.54
|
| Rate for Payer: BCBS Transplant Transplant |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Media |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
1755705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]
|
Facility
OP
|
$46.25
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
ERX76923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$55.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.54
|
| Rate for Payer: BCBS Transplant Transplant |
$27.75
|
| Rate for Payer: Blue Shield of California Commercial |
$34.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$32.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.31
|
| Rate for Payer: Dignity Health Media |
$39.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.50
|
| Rate for Payer: Galaxy Health WC |
$39.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.10
|
| Rate for Payer: Multiplan Commercial |
$37.00
|
| Rate for Payer: Networks By Design Commercial |
$23.12
|
| Rate for Payer: Prime Health Services Commercial |
$39.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.12
|
| Rate for Payer: United Healthcare All Other HMO |
$23.12
|
| Rate for Payer: United Healthcare HMO Rider |
$23.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$39.31
|
|
|
EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]
|
Facility
IP
|
$46.25
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
ERX76923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$39.31 |
| Rate for Payer: Blue Shield of California Commercial |
$32.93
|
| Rate for Payer: Blue Shield of California EPN |
$23.68
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$32.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.50
|
| Rate for Payer: Galaxy Health WC |
$39.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.10
|
| Rate for Payer: Multiplan Commercial |
$37.00
|
| Rate for Payer: Networks By Design Commercial |
$23.12
|
| Rate for Payer: Prime Health Services Commercial |
$39.31
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Media |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Media |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Blue Shield of California Commercial |
$141.66
|
| Rate for Payer: Blue Shield of California Commercial |
$228.33
|
| Rate for Payer: Blue Shield of California Commercial |
$228.34
|
| Rate for Payer: Blue Shield of California EPN |
$164.19
|
| Rate for Payer: Blue Shield of California EPN |
$101.87
|
| Rate for Payer: Blue Shield of California EPN |
$164.20
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
OP
|
$320.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: BCBS Transplant Transplant |
$119.38
|
| Rate for Payer: BCBS Transplant Transplant |
$192.42
|
| Rate for Payer: BCBS Transplant Transplant |
$192.41
|
| Rate for Payer: Blue Shield of California Commercial |
$236.35
|
| Rate for Payer: Blue Shield of California Commercial |
$146.63
|
| Rate for Payer: Blue Shield of California Commercial |
$236.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$240.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$240.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$160.34
|
| Rate for Payer: United Healthcare All Other HMO |
$160.35
|
| Rate for Payer: United Healthcare HMO Rider |
$99.48
|
| Rate for Payer: United Healthcare HMO Rider |
$160.35
|
| Rate for Payer: United Healthcare HMO Rider |
$160.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
OP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: BCBS Transplant Transplant |
$119.38
|
| Rate for Payer: Blue Shield of California Commercial |
$146.63
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$99.48
|
| Rate for Payer: United Healthcare HMO Rider |
$99.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Blue Shield of California Commercial |
$141.66
|
| Rate for Payer: Blue Shield of California EPN |
$101.87
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
IP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.94 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Blue Shield of California Commercial |
$456.68
|
| Rate for Payer: Blue Shield of California EPN |
$328.40
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$256.56
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
OP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$545.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: BCBS Transplant Transplant |
$384.84
|
| Rate for Payer: Blue Shield of California Commercial |
$472.71
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$481.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$513.12
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.70
|
| Rate for Payer: United Healthcare All Other HMO |
$320.70
|
| Rate for Payer: United Healthcare HMO Rider |
$320.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
IP
|
$64.15
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$54.53 |
| Rate for Payer: Blue Shield of California Commercial |
$45.67
|
| Rate for Payer: Blue Shield of California Commercial |
$28.33
|
| Rate for Payer: Blue Shield of California EPN |
$20.37
|
| Rate for Payer: Blue Shield of California EPN |
$32.84
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cigna of CA HMO |
$44.90
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.90
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.92
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Networks By Design Commercial |
$19.90
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
OP
|
$64.15
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$54.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.76
|
| Rate for Payer: BCBS Transplant Transplant |
$38.49
|
| Rate for Payer: BCBS Transplant Transplant |
$23.87
|
| Rate for Payer: Blue Shield of California Commercial |
$29.33
|
| Rate for Payer: Blue Shield of California Commercial |
$47.28
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cigna of CA HMO |
$44.90
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.57
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$14.40
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$31.83
|
| Rate for Payer: Multiplan Commercial |
$51.32
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.08
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$32.08
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
IP
|
$96.22
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Blue Shield of California Commercial |
$68.51
|
| Rate for Payer: Blue Shield of California Commercial |
$42.50
|
| Rate for Payer: Blue Shield of California EPN |
$49.26
|
| Rate for Payer: Blue Shield of California EPN |
$30.56
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
|
