|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$36,666.31
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$23,157.67 |
| Max. Negotiated Rate |
$36,666.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,157.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,596.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36,666.31
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$21,298.05
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$13,451.40 |
| Max. Negotiated Rate |
$21,298.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,451.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,029.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,298.05
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$11,549.36
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$7,294.33 |
| Max. Negotiated Rate |
$11,549.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,294.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,692.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,549.36
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$40,144.37
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$40,144.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,144.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,931.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,198.72
|
| Rate for Payer: EPIC Health Plan Senior |
$24,132.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,938.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,714.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,397.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,938.62
|
| Rate for Payer: Prime Health Services Medicare |
$23,254.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
COAGULATION FACTOR IX (RECOMB) 1,000 UNIT INTRAVENOUS SOLUTION [203437]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Medicare |
$1.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.05
|
|
|
COAGULATION FACTOR IX (RECOMB) 1,000 UNIT INTRAVENOUS SOLUTION [203437]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
|
|
COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION [203438]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
|
|
COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION [203438]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Medicare |
$1.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.05
|
|
|
COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION [203435]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Medicare |
$1.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.05
|
|
|
COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION [203435]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
|
|
COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [203439]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
|
|
COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [203439]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Medicare |
$1.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.05
|
|
|
COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [203436]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
|
|
COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [203436]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Medicare |
$1.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Prime Health Services Medicare |
$2.94
|
| Rate for Payer: Riverside University Health System MISP |
$3.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Prime Health Services Medicare |
$2.94
|
| Rate for Payer: Riverside University Health System MISP |
$3.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Senior |
$1.42
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.83
|
| Rate for Payer: Cigna of CA HMO |
$2.48
|
| Rate for Payer: Cigna of CA PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$3.01
|
| Rate for Payer: Global Benefits Group Commercial |
$2.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Networks By Design Commercial |
$1.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.77
|
| Rate for Payer: Prime Health Services Commercial |
$3.01
|
| Rate for Payer: Prime Health Services Medicare |
$2.94
|
| Rate for Payer: Riverside University Health System MISP |
$3.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3.05
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
|
OP
|
$12.59
|
|
|
Service Code
|
NDC 6195814011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7.98
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Central Health Plan Commercial |
$10.07
|
| Rate for Payer: Cigna of CA HMO |
$8.81
|
| Rate for Payer: Cigna of CA PPO |
$8.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: EPIC Health Plan Senior |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$10.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Networks By Design Commercial |
$8.18
|
| Rate for Payer: Prime Health Services Commercial |
$10.70
|
| Rate for Payer: Riverside University Health System MISP |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10.70
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
|
IP
|
$12.59
|
|
|
Service Code
|
NDC 6195814011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$10.10
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$5.67
|
| Rate for Payer: Central Health Plan Commercial |
$10.07
|
| Rate for Payer: Cigna of CA HMO |
$8.81
|
| Rate for Payer: Cigna of CA PPO |
$8.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: EPIC Health Plan Senior |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$10.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Networks By Design Commercial |
$8.18
|
| Rate for Payer: Prime Health Services Commercial |
$10.70
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
HCPCS C9046
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Adventist Health Commercial |
$21.54
|
| Rate for Payer: Blue Shield of California Commercial |
$58.95
|
| Rate for Payer: Blue Shield of California Commercial |
$86.38
|
| Rate for Payer: Blue Shield of California EPN |
$54.28
|
| Rate for Payer: Blue Shield of California EPN |
$37.04
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$48.46
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Central Health Plan Commercial |
$86.16
|
| Rate for Payer: Cigna of CA HMO |
$75.39
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$75.39
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Senior |
$43.08
|
| Rate for Payer: EPIC Health Plan Senior |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Galaxy Health WC |
$91.55
|
| Rate for Payer: Global Benefits Group Commercial |
$64.62
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.54
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$53.85
|
| Rate for Payer: Networks By Design Commercial |
$36.75
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Prime Health Services Commercial |
$91.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.58
|
| Rate for Payer: United Healthcare All Other HMO |
$26.85
|
| Rate for Payer: United Healthcare All Other HMO |
$39.34
|
| Rate for Payer: United Healthcare HMO Rider |
$38.49
|
| Rate for Payer: United Healthcare HMO Rider |
$26.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.07
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
HCPCS C9046
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Adventist Health Commercial |
$21.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$48.46
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$48.46
|
| Rate for Payer: Central Health Plan Commercial |
$86.16
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA HMO |
$75.39
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$75.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Senior |
$43.08
|
| Rate for Payer: EPIC Health Plan Senior |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$91.55
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$64.62
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.39
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$53.85
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Prime Health Services Commercial |
$91.55
|
| Rate for Payer: Riverside University Health System MISP |
$43.08
|
| Rate for Payer: Riverside University Health System MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.42
|
| Rate for Payer: United Healthcare All Other HMO |
$39.34
|
| Rate for Payer: United Healthcare All Other HMO |
$26.85
|
| Rate for Payer: United Healthcare HMO Rider |
$26.27
|
| Rate for Payer: United Healthcare HMO Rider |
$38.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$91.55
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$5,224.81
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$3,299.88 |
| Max. Negotiated Rate |
$5,224.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,299.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,932.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,224.81
|
|
