|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
OP
|
$59.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: 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 |
$57.73
|
| Rate for Payer: BCBS Transplant Transplant |
$35.81
|
| Rate for Payer: Blue Shield of California Commercial |
$70.91
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| 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: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.77
|
| 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 |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Multiplan Commercial |
$47.75
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.11
|
| Rate for Payer: United Healthcare All Other HMO |
$29.84
|
| Rate for Payer: United Healthcare HMO Rider |
$48.11
|
| Rate for Payer: United Healthcare HMO Rider |
$29.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.84
|
| 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 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
OP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$1,090.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: 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 |
$769.68
|
| Rate for Payer: Blue Shield of California Commercial |
$945.42
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$962.10
|
| 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 |
$855.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$1,026.24
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other HMO |
$641.40
|
| Rate for Payer: United Healthcare HMO Rider |
$641.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
IP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.87 |
| Max. Negotiated Rate |
$1,090.38 |
| Rate for Payer: Blue Shield of California Commercial |
$913.35
|
| Rate for Payer: Blue Shield of California EPN |
$656.79
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$513.12
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.87
|
| Rate for Payer: Multiplan Commercial |
$1,026.24
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
OP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: 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 |
$76.97
|
| Rate for Payer: Blue Shield of California Commercial |
$94.54
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.21
|
| 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 |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.14
|
| Rate for Payer: United Healthcare All Other HMO |
$64.14
|
| Rate for Payer: United Healthcare HMO Rider |
$64.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
IP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$109.04 |
| Rate for Payer: Blue Shield of California Commercial |
$91.34
|
| Rate for Payer: Blue Shield of California EPN |
$65.68
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.79
|
| Rate for Payer: Multiplan Commercial |
$102.62
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
IP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Blue Shield of California Commercial |
$94.24
|
| Rate for Payer: Blue Shield of California EPN |
$67.77
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.94
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
OP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: BCBS Transplant Transplant |
$79.42
|
| Rate for Payer: Blue Shield of California Commercial |
$97.55
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$99.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: IEHP Medi-Cal |
$12.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.67
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.18
|
| Rate for Payer: United Healthcare All Other HMO |
$66.18
|
| Rate for Payer: United Healthcare HMO Rider |
$66.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
OP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: BCBS Transplant Transplant |
$158.83
|
| Rate for Payer: Blue Shield of California Commercial |
$195.10
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$198.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: IEHP Medi-Cal |
$12.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.67
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$211.78
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.36
|
| Rate for Payer: United Healthcare All Other HMO |
$132.36
|
| Rate for Payer: United Healthcare HMO Rider |
$132.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
IP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$225.01 |
| Rate for Payer: Blue Shield of California Commercial |
$188.48
|
| Rate for Payer: Blue Shield of California EPN |
$135.54
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.89
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.53
|
| Rate for Payer: Multiplan Commercial |
$211.78
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
IP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Blue Shield of California Commercial |
$18.85
|
| Rate for Payer: Blue Shield of California EPN |
$13.55
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.59
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$21.18
|
| Rate for Payer: Networks By Design Commercial |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
OP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$49.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: BCBS Transplant Transplant |
$15.88
|
| Rate for Payer: Blue Shield of California Commercial |
$19.51
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: IEHP Medi-Cal |
$12.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.67
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$21.18
|
| Rate for Payer: Networks By Design Commercial |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
IP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Blue Shield of California Commercial |
$28.27
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$31.77
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
OP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$49.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: BCBS Transplant Transplant |
$23.83
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: IEHP Medi-Cal |
$12.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.67
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$31.77
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.86
|
| Rate for Payer: United Healthcare All Other HMO |
$19.86
|
| Rate for Payer: United Healthcare HMO Rider |
$19.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
IP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.07 |
| Max. Negotiated Rate |
$450.02 |
| Rate for Payer: Blue Shield of California Commercial |
$376.96
|
| Rate for Payer: Blue Shield of California EPN |
$271.07
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.78
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.07
|
| Rate for Payer: Multiplan Commercial |
$423.55
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
OP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$450.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: BCBS Transplant Transplant |
$317.66
|
| Rate for Payer: Blue Shield of California Commercial |
$390.20
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$397.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: IEHP Medi-Cal |
$12.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.67
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$423.55
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.72
|
| Rate for Payer: United Healthcare HMO Rider |
$264.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
IP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Blue Shield of California Commercial |
$37.69
|
| Rate for Payer: Blue Shield of California EPN |
$27.11
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.18
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$42.35
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
OP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$49.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.53
|
| Rate for Payer: BCBS Transplant Transplant |
$31.76
|
| Rate for Payer: Blue Shield of California Commercial |
$39.02
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.83
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.83
|
| Rate for Payer: IEHP Medi-Cal |
$12.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$12.67
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$42.35
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$26.47
|
| Rate for Payer: United Healthcare HMO Rider |
$26.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
OP
|
$53.40
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1771290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: BCBS Transplant Transplant |
$32.04
|
| Rate for Payer: Blue Shield of California Commercial |
$39.36
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Media |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.70
|
| Rate for Payer: United Healthcare All Other HMO |
$26.70
|
| Rate for Payer: United Healthcare HMO Rider |
$26.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
IP
|
$59.02
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
NDC155307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$50.17 |
| Rate for Payer: Blue Shield of California Commercial |
$42.02
|
| Rate for Payer: Blue Shield of California EPN |
$30.22
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cigna of CA HMO |
$41.31
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.61
|
| Rate for Payer: Galaxy Health WC |
$50.17
|
| Rate for Payer: Global Benefits Group Commercial |
$35.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.22
|
| Rate for Payer: Networks By Design Commercial |
$29.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.17
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
IP
|
$53.40
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1771290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Blue Shield of California Commercial |
$38.02
|
| Rate for Payer: Blue Shield of California EPN |
$27.34
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.82
|
| Rate for Payer: Multiplan Commercial |
$42.72
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
OP
|
$59.02
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
NDC155307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: BCBS Transplant Transplant |
$35.41
|
| Rate for Payer: Blue Shield of California Commercial |
$43.50
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cigna of CA HMO |
$41.31
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.17
|
| Rate for Payer: Dignity Health Media |
$50.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.61
|
| Rate for Payer: Galaxy Health WC |
$50.17
|
| Rate for Payer: Global Benefits Group Commercial |
$35.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.22
|
| Rate for Payer: Networks By Design Commercial |
$29.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.51
|
| Rate for Payer: United Healthcare All Other HMO |
$29.51
|
| Rate for Payer: United Healthcare HMO Rider |
$29.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.17
|
| Rate for Payer: Vantage Medical Group Senior |
$50.17
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
OP
|
$22.43
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: BCBS Transplant Transplant |
$13.46
|
| Rate for Payer: Blue Shield of California Commercial |
$16.53
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Media |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other HMO |
$11.22
|
| Rate for Payer: United Healthcare HMO Rider |
$11.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
IP
|
$22.43
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Blue Shield of California Commercial |
$15.97
|
| Rate for Payer: Blue Shield of California EPN |
$11.48
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
IP
|
$54.17
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Blue Shield of California Commercial |
$38.57
|
| Rate for Payer: Blue Shield of California EPN |
$27.74
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
OP
|
$54.17
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$100.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.85
|
| Rate for Payer: BCBS Transplant Transplant |
$32.50
|
| Rate for Payer: Blue Shield of California Commercial |
$39.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Media |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$43.34
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.08
|
| Rate for Payer: United Healthcare All Other HMO |
$27.08
|
| Rate for Payer: United Healthcare HMO Rider |
$27.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
