|
CLOZAPINE 50 MG TABLET [41637]
|
Facility
OP
|
$1.58
|
|
|
Service Code
|
NDC 0093-4404-01
|
| Hospital Charge Code |
ERX41637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: BCBS Transplant Transplant |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Central Health Plan Commercial |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.11
|
| Rate for Payer: Cigna of CA PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.63
|
| Rate for Payer: Galaxy Health WC |
$1.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.18
|
| Rate for Payer: IEHP medi-cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$1.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: Riverside University Health MISP |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1.34
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$6,917.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,917.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$8,243.49
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$9,213.78 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,213.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,979.75
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$11,903.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,903.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$14,184.51
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$22,672.66 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,672.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$27,018.25
|
|
|
COAGULATION DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 813
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
COAGULATION FACTOR IX (RECOMB) 1,000 UNIT INTRAVENOUS SOLUTION [203437]
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX19814
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Caremore Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.87
|
| Rate for Payer: IEHP medi-cal |
$2.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1.75
|
| Rate for Payer: Innovage PACE Commercial |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Medicare |
$1.86
|
| Rate for Payer: Riverside University Health MISP |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.97
|
| Rate for Payer: United Healthcare HMO Rider |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
COAGULATION FACTOR IX (RECOMB) 1,000 UNIT INTRAVENOUS SOLUTION [203437]
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX19814
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
|
|
COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION [203438]
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Caremore Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.87
|
| Rate for Payer: IEHP medi-cal |
$2.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1.75
|
| Rate for Payer: Innovage PACE Commercial |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Medicare |
$1.86
|
| Rate for Payer: Riverside University Health MISP |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.97
|
| Rate for Payer: United Healthcare HMO Rider |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION [203438]
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
|
|
COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION [203435]
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Caremore Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.87
|
| Rate for Payer: IEHP medi-cal |
$2.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1.75
|
| Rate for Payer: Innovage PACE Commercial |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Medicare |
$1.86
|
| Rate for Payer: Riverside University Health MISP |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.97
|
| Rate for Payer: United Healthcare HMO Rider |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION [203435]
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203435
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
|
|
COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [203439]
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
|
|
COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [203439]
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Caremore Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.87
|
| Rate for Payer: IEHP medi-cal |
$2.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1.75
|
| Rate for Payer: Innovage PACE Commercial |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Medicare |
$1.86
|
| Rate for Payer: Riverside University Health MISP |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.97
|
| Rate for Payer: United Healthcare HMO Rider |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [203436]
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
|
|
COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [203436]
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
CPT J7195
|
| Hospital Charge Code |
ERX203436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Caremore Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Cash Price |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Cigna of CA HMO |
$1.35
|
| Rate for Payer: Cigna of CA PPO |
$1.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$1.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.87
|
| Rate for Payer: IEHP medi-cal |
$2.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1.75
|
| Rate for Payer: Innovage PACE Commercial |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$1.45
|
| Rate for Payer: Networks By Design Commercial |
$0.97
|
| Rate for Payer: Prime Health Services Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Medicare |
$1.86
|
| Rate for Payer: Riverside University Health MISP |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO |
$0.97
|
| Rate for Payer: United Healthcare HMO Rider |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
OP
|
$3.08
|
|
|
Service Code
|
CPT J7189
|
| Hospital Charge Code |
ERX92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Caremore Medicare Advantage |
$2.43
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.98
|
| Rate for Payer: IEHP medi-cal |
$4.01
|
| Rate for Payer: IEHP Medicare Advantage |
$2.43
|
| Rate for Payer: Innovage PACE Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Medicare |
$2.57
|
| Rate for Payer: Riverside University Health MISP |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
IP
|
$3.08
|
|
|
Service Code
|
CPT J7189
|
| Hospital Charge Code |
ERX92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
OP
|
$3.08
|
|
|
Service Code
|
CPT J7189
|
| Hospital Charge Code |
ERX92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Caremore Medicare Advantage |
$2.43
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.98
|
| Rate for Payer: IEHP medi-cal |
$4.01
|
| Rate for Payer: IEHP Medicare Advantage |
$2.43
|
| Rate for Payer: Innovage PACE Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Medicare |
$2.57
|
| Rate for Payer: Riverside University Health MISP |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
IP
|
$3.08
|
|
|
Service Code
|
CPT J7189
|
| Hospital Charge Code |
ERX92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
OP
|
$3.08
|
|
|
Service Code
|
CPT J7189
|
| Hospital Charge Code |
ERX92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Caremore Medicare Advantage |
$2.43
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.98
|
| Rate for Payer: IEHP medi-cal |
$4.01
|
| Rate for Payer: IEHP Medicare Advantage |
$2.43
|
| Rate for Payer: Innovage PACE Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Medicare |
$2.57
|
| Rate for Payer: Riverside University Health MISP |
$2.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
IP
|
$3.08
|
|
|
Service Code
|
CPT J7189
|
| Hospital Charge Code |
ERX92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Central Health Plan Commercial |
$2.46
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
OP
|
$11.33
|
|
|
Service Code
|
NDC 61958-1401-1
|
| Hospital Charge Code |
ERX207759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.69
|
| Rate for Payer: BCBS Transplant Transplant |
$6.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$5.54
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Central Health Plan Commercial |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$7.93
|
| Rate for Payer: Cigna of CA PPO |
$7.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.63
|
| Rate for Payer: Global Benefits Group Commercial |
$6.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.50
|
| Rate for Payer: IEHP medi-cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$8.50
|
| Rate for Payer: Networks By Design Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Commercial |
$9.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.80
|
| Rate for Payer: Riverside University Health MISP |
$4.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.66
|
| Rate for Payer: United Healthcare All Other HMO |
$5.66
|
| Rate for Payer: United Healthcare HMO Rider |
$5.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.63
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
IP
|
$11.33
|
|
|
Service Code
|
NDC 61958-1401-1
|
| Hospital Charge Code |
ERX207759
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Central Health Plan Commercial |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$7.93
|
| Rate for Payer: Cigna of CA PPO |
$7.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.63
|
| Rate for Payer: Global Benefits Group Commercial |
$6.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$8.50
|
| Rate for Payer: Networks By Design Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Commercial |
$9.63
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
OP
|
$73.50
|
|
|
Service Code
|
CPT C9046
|
| Hospital Charge Code |
1734001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.42
|
| 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 |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.99
|
| Rate for Payer: BCBS Transplant Transplant |
$44.10
|
| Rate for Payer: BCBS Transplant Transplant |
$39.69
|
| Rate for Payer: Blue Shield of California Commercial |
$46.23
|
| Rate for Payer: Blue Shield of California Commercial |
$41.61
|
| Rate for Payer: Blue Shield of California EPN |
$35.94
|
| Rate for Payer: Blue Shield of California EPN |
$32.35
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Central Health Plan Commercial |
$52.92
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA HMO |
$46.30
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$46.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.46
|
| Rate for Payer: Galaxy Health WC |
$56.23
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$49.61
|
| Rate for Payer: IEHP medi-cal |
$25.72
|
| Rate for Payer: IEHP medi-cal |
$23.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$49.61
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$33.08
|
| Rate for Payer: Networks By Design Commercial |
$36.75
|
| Rate for Payer: Prime Health Services Commercial |
$56.23
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Riverside University Health MISP |
$26.46
|
| Rate for Payer: Riverside University Health MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$33.08
|
| Rate for Payer: United Healthcare HMO Rider |
$33.08
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.23
|
| 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 |
$56.23
|
|
