|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California EPN |
$100.28
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Central Health Plan Commercial |
$159.17
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.79
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Central Health Plan Commercial |
$159.17
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$577.26 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$389.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Central Health Plan Commercial |
$513.12
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$577.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other HMO |
$234.30
|
| Rate for Payer: United Healthcare HMO Rider |
$229.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.28 |
| Max. Negotiated Rate |
$577.26 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Blue Shield of California Commercial |
$495.80
|
| Rate for Payer: Blue Shield of California EPN |
$323.27
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Central Health Plan Commercial |
$513.12
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.56
|
| Rate for Payer: EPIC Health Plan Senior |
$256.56
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$577.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.28
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.72
|
| Rate for Payer: United Healthcare All Other HMO |
$234.30
|
| Rate for Payer: United Healthcare HMO Rider |
$229.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.06
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
OP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$57.73 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Central Health Plan Commercial |
$51.32
|
| Rate for Payer: Central Health Plan Commercial |
$31.83
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA HMO |
$44.91
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Networks By Design Commercial |
$19.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO |
$14.54
|
| Rate for Payer: United Healthcare All Other HMO |
$23.43
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
IP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$57.73 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Blue Shield of California Commercial |
$49.59
|
| Rate for Payer: Blue Shield of California Commercial |
$30.76
|
| Rate for Payer: Blue Shield of California EPN |
$20.05
|
| Rate for Payer: Blue Shield of California EPN |
$32.33
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Central Health Plan Commercial |
$51.32
|
| Rate for Payer: Central Health Plan Commercial |
$31.83
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA HMO |
$44.91
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.66
|
| Rate for Payer: EPIC Health Plan Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Senior |
$25.66
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$19.89
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO |
$23.43
|
| Rate for Payer: United Healthcare All Other HMO |
$14.54
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.01
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Blue Shield of California Commercial |
$74.38
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California EPN |
$30.08
|
| Rate for Payer: Blue Shield of California EPN |
$48.49
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: Central Health Plan Commercial |
$47.75
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Senior |
$23.88
|
| Rate for Payer: EPIC Health Plan Senior |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.11
|
| Rate for Payer: United Healthcare All Other HMO |
$35.15
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.51
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: Central Health Plan Commercial |
$47.75
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.11
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$35.15
|
| Rate for Payer: United Healthcare HMO Rider |
$21.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$115.45 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Central Health Plan Commercial |
$102.62
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: InnovAge PACE Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: Prime Health Services Medicare |
$8.14
|
| Rate for Payer: Riverside University Health System MISP |
$8.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.14
|
| Rate for Payer: United Healthcare All Other HMO |
$46.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$115.45 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Blue Shield of California Commercial |
$99.16
|
| Rate for Payer: Blue Shield of California EPN |
$64.65
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Central Health Plan Commercial |
$102.62
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.31
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.66
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.14
|
| Rate for Payer: United Healthcare All Other HMO |
$46.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.01
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$119.12 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California Commercial |
$102.31
|
| Rate for Payer: Blue Shield of California EPN |
$66.71
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Central Health Plan Commercial |
$105.89
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.94
|
| Rate for Payer: EPIC Health Plan Senior |
$52.94
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.67
|
| Rate for Payer: United Healthcare All Other HMO |
$48.35
|
| Rate for Payer: United Healthcare HMO Rider |
$47.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.35
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$119.12 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Central Health Plan Commercial |
$105.89
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: InnovAge PACE Commercial |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: Prime Health Services Medicare |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.67
|
| Rate for Payer: United Healthcare All Other HMO |
$48.35
|
| Rate for Payer: United Healthcare HMO Rider |
$47.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$264.72
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$238.25 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Blue Shield of California Commercial |
$204.63
|
| Rate for Payer: Blue Shield of California EPN |
$133.42
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Central Health Plan Commercial |
$211.78
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.89
|
| Rate for Payer: EPIC Health Plan Senior |
$105.89
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.94
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.35
|
| Rate for Payer: United Healthcare All Other HMO |
$96.70
|
| Rate for Payer: United Healthcare HMO Rider |
$94.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$264.72
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$238.25 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Central Health Plan Commercial |
$211.78
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: InnovAge PACE Commercial |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: Prime Health Services Medicare |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.35
|
| Rate for Payer: United Healthcare All Other HMO |
$96.70
|
| Rate for Payer: United Healthcare HMO Rider |
$94.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$20.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.34
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Central Health Plan Commercial |
$21.18
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.59
|
| Rate for Payer: EPIC Health Plan Senior |
$10.59
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.67
|
| Rate for Payer: United Healthcare HMO Rider |
$9.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.67
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Central Health Plan Commercial |
$21.18
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: InnovAge PACE Commercial |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.67
|
| Rate for Payer: United Healthcare HMO Rider |
$9.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Blue Shield of California Commercial |
$30.70
|
| Rate for Payer: Blue Shield of California EPN |
$20.01
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Central Health Plan Commercial |
$31.77
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Senior |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.94
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.51
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Central Health Plan Commercial |
$31.77
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: InnovAge PACE Commercial |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: Prime Health Services Medicare |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.51
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$476.50 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Central Health Plan Commercial |
$423.55
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: InnovAge PACE Commercial |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: Prime Health Services Medicare |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.70
|
| Rate for Payer: United Healthcare All Other HMO |
$193.40
|
| Rate for Payer: United Healthcare HMO Rider |
$189.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
IP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$476.50 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Blue Shield of California Commercial |
$409.26
|
| Rate for Payer: Blue Shield of California EPN |
$266.84
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Central Health Plan Commercial |
$423.55
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.78
|
| Rate for Payer: EPIC Health Plan Senior |
$211.78
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.89
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.70
|
| Rate for Payer: United Healthcare All Other HMO |
$193.40
|
| Rate for Payer: United Healthcare HMO Rider |
$189.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.39
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Adventist Health Commercial |
$10.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Central Health Plan Commercial |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.21
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: InnovAge PACE Commercial |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Medicare |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.87
|
| Rate for Payer: United Healthcare All Other HMO |
$19.34
|
| Rate for Payer: United Healthcare HMO Rider |
$18.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Adventist Health Commercial |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$40.92
|
| Rate for Payer: Blue Shield of California EPN |
$26.68
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Central Health Plan Commercial |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.18
|
| Rate for Payer: EPIC Health Plan Senior |
$21.18
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.87
|
| Rate for Payer: United Healthcare All Other HMO |
$19.34
|
| Rate for Payer: United Healthcare HMO Rider |
$18.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$66.31
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Adventist Health Commercial |
$13.26
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Blue Shield of California Commercial |
$51.26
|
| Rate for Payer: Blue Shield of California Commercial |
$41.28
|
| Rate for Payer: Blue Shield of California EPN |
$26.91
|
| Rate for Payer: Blue Shield of California EPN |
$33.42
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$53.05
|
| Rate for Payer: Central Health Plan Commercial |
$42.72
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA HMO |
$46.42
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Galaxy Health WC |
$56.36
|
| Rate for Payer: Global Benefits Group Commercial |
$39.79
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Networks By Design Commercial |
$33.16
|
| Rate for Payer: Prime Health Services Commercial |
$56.36
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.89
|
| Rate for Payer: United Healthcare All Other HMO |
$24.22
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$23.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.72
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Adventist Health Commercial |
$13.26
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.67
|
| Rate for Payer: Blue Shield of California Commercial |
$24.67
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$53.05
|
| Rate for Payer: Central Health Plan Commercial |
$42.72
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA HMO |
$46.42
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$21.36
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$56.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$39.79
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$26.70
|
| Rate for Payer: InnovAge PACE Commercial |
$33.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.42
|
| Rate for Payer: Multiplan Commercial |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Networks By Design Commercial |
$33.16
|
| Rate for Payer: Prime Health Services Commercial |
$56.36
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: Riverside University Health System MISP |
$21.36
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.04
|
| Rate for Payer: United Healthcare All Other HMO |
$24.22
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$23.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.36
|
| Rate for Payer: Vantage Medical Group Senior |
$56.36
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.61
|
| Rate for Payer: Blue Shield of California Commercial |
$24.67
|
| Rate for Payer: Blue Shield of California EPN |
$22.43
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Central Health Plan Commercial |
$17.94
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.70
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: Riverside University Health System MISP |
$8.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.42
|
| Rate for Payer: United Healthcare All Other HMO |
$8.19
|
| Rate for Payer: United Healthcare HMO Rider |
$8.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
|
