|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.19 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California Commercial |
$17.34
|
| Rate for Payer: Blue Shield of California EPN |
$11.30
|
| 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: 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: 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: 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: 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
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.63
|
| 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 |
$29.79
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Central Health Plan Commercial |
$43.34
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$27.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$40.63
|
| Rate for Payer: Networks By Design Commercial |
$27.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: Riverside University Health System MISP |
$21.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$19.79
|
| Rate for Payer: United Healthcare HMO Rider |
$19.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California Commercial |
$41.87
|
| Rate for Payer: Blue Shield of California EPN |
$27.30
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Central Health Plan Commercial |
$43.34
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$40.63
|
| Rate for Payer: Networks By Design Commercial |
$27.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.33
|
| Rate for Payer: United Healthcare All Other HMO |
$19.79
|
| Rate for Payer: United Healthcare HMO Rider |
$19.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.74
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$23.36 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.03
|
| Rate for Payer: Blue Shield of California EPN |
$12.75
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: InnovAge PACE Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$4.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$23.36 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.03
|
| Rate for Payer: Blue Shield of California EPN |
$12.75
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.89
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.50
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2.70
|
| Rate for Payer: InnovAge PACE Commercial |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Riverside University Health System MISP |
$4.51
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$4.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Adventist Health Commercial |
$16.10
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California EPN |
$40.57
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Central Health Plan Commercial |
$64.40
|
| Rate for Payer: Cigna of CA HMO |
$56.35
|
| Rate for Payer: Cigna of CA PPO |
$56.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.20
|
| Rate for Payer: EPIC Health Plan Senior |
$32.20
|
| Rate for Payer: Galaxy Health WC |
$68.42
|
| Rate for Payer: Global Benefits Group Commercial |
$48.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$60.38
|
| Rate for Payer: Networks By Design Commercial |
$40.25
|
| Rate for Payer: Prime Health Services Commercial |
$68.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.21
|
| Rate for Payer: United Healthcare All Other HMO |
$29.41
|
| Rate for Payer: United Healthcare HMO Rider |
$28.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.36
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
|
OP
|
$80.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Adventist Health Commercial |
$16.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.32
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Cash Price |
$44.28
|
| Rate for Payer: Central Health Plan Commercial |
$64.40
|
| Rate for Payer: Cigna of CA HMO |
$56.35
|
| Rate for Payer: Cigna of CA PPO |
$56.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.20
|
| Rate for Payer: EPIC Health Plan Senior |
$32.20
|
| Rate for Payer: Galaxy Health WC |
$68.42
|
| Rate for Payer: Global Benefits Group Commercial |
$48.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.21
|
| Rate for Payer: InnovAge PACE Commercial |
$40.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$60.38
|
| Rate for Payer: Networks By Design Commercial |
$40.25
|
| Rate for Payer: Prime Health Services Commercial |
$68.42
|
| Rate for Payer: Riverside University Health System MISP |
$32.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.21
|
| Rate for Payer: United Healthcare All Other HMO |
$29.41
|
| Rate for Payer: United Healthcare HMO Rider |
$28.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.42
|
| Rate for Payer: Vantage Medical Group Senior |
$68.42
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
IP
|
$455.28
|
|
|
Service Code
|
NDC 59676-030-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$91.06 |
| Max. Negotiated Rate |
$409.75 |
| Rate for Payer: Adventist Health Commercial |
$91.06
|
| Rate for Payer: Blue Shield of California Commercial |
$351.93
|
| Rate for Payer: Blue Shield of California EPN |
$229.46
|
| Rate for Payer: Cash Price |
$250.41
|
| Rate for Payer: Central Health Plan Commercial |
$364.22
|
| Rate for Payer: Cigna of CA HMO |
$318.70
|
| Rate for Payer: Cigna of CA PPO |
$318.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.11
|
| Rate for Payer: EPIC Health Plan Senior |
$182.11
|
| Rate for Payer: Galaxy Health WC |
$386.99
|
| Rate for Payer: Global Benefits Group Commercial |
$273.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.06
|
| Rate for Payer: Multiplan Commercial |
$341.46
|
| Rate for Payer: Networks By Design Commercial |
$295.93
|
| Rate for Payer: Prime Health Services Commercial |
$386.99
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
|
OP
|
$455.28
|
|
|
Service Code
|
NDC 59676-030-56
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$91.06 |
| Max. Negotiated Rate |
$409.75 |
| Rate for Payer: Adventist Health Commercial |
$91.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.39
|
| Rate for Payer: Blue Shield of California Commercial |
$278.18
|
| Rate for Payer: Blue Shield of California EPN |
$181.66
|
| Rate for Payer: Cash Price |
$250.41
|
| Rate for Payer: Central Health Plan Commercial |
$364.22
|
| Rate for Payer: Cigna of CA HMO |
$318.70
|
| Rate for Payer: Cigna of CA PPO |
$318.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.11
|
| Rate for Payer: EPIC Health Plan Senior |
$182.11
|
| Rate for Payer: Galaxy Health WC |
$386.99
|
| Rate for Payer: Global Benefits Group Commercial |
$273.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.75
|
| Rate for Payer: InnovAge PACE Commercial |
$227.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.70
|
| Rate for Payer: Multiplan Commercial |
$341.46
|
| Rate for Payer: Networks By Design Commercial |
$295.93
|
| Rate for Payer: Prime Health Services Commercial |
$386.99
|
| Rate for Payer: Riverside University Health System MISP |
$182.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.64
|
| Rate for Payer: United Healthcare All Other HMO |
$227.64
|
| Rate for Payer: United Healthcare HMO Rider |
$227.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.99
|
| Rate for Payer: Vantage Medical Group Senior |
$386.99
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
IP
|
$607.04
|
|
|
Service Code
|
NDC 59676-040-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$546.34 |
| Rate for Payer: Adventist Health Commercial |
$121.41
|
| Rate for Payer: Blue Shield of California Commercial |
$469.24
|
| Rate for Payer: Blue Shield of California EPN |
$305.95
|
| Rate for Payer: Cash Price |
$333.87
|
| Rate for Payer: Central Health Plan Commercial |
$485.63
|
| Rate for Payer: Cigna of CA HMO |
$424.93
|
| Rate for Payer: Cigna of CA PPO |
$424.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.82
|
| Rate for Payer: EPIC Health Plan Senior |
$242.82
|
| Rate for Payer: Galaxy Health WC |
$515.98
|
| Rate for Payer: Global Benefits Group Commercial |
$364.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$546.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$404.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.41
|
| Rate for Payer: Multiplan Commercial |
$455.28
|
| Rate for Payer: Networks By Design Commercial |
$394.58
|
| Rate for Payer: Prime Health Services Commercial |
$515.98
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
|
OP
|
$607.04
|
|
|
Service Code
|
NDC 59676-040-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$546.34 |
| Rate for Payer: Adventist Health Commercial |
$121.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$515.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$333.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.51
|
| Rate for Payer: Blue Shield of California Commercial |
$370.90
|
| Rate for Payer: Blue Shield of California EPN |
$242.21
|
| Rate for Payer: Cash Price |
$333.87
|
| Rate for Payer: Central Health Plan Commercial |
$485.63
|
| Rate for Payer: Cigna of CA HMO |
$424.93
|
| Rate for Payer: Cigna of CA PPO |
$424.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$515.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.82
|
| Rate for Payer: EPIC Health Plan Senior |
$242.82
|
| Rate for Payer: Galaxy Health WC |
$515.98
|
| Rate for Payer: Global Benefits Group Commercial |
$364.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$546.34
|
| Rate for Payer: InnovAge PACE Commercial |
$303.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$404.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$424.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$424.93
|
| Rate for Payer: Multiplan Commercial |
$455.28
|
| Rate for Payer: Networks By Design Commercial |
$394.58
|
| Rate for Payer: Prime Health Services Commercial |
$515.98
|
| Rate for Payer: Riverside University Health System MISP |
$242.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$364.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$364.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.52
|
| Rate for Payer: United Healthcare All Other HMO |
$303.52
|
| Rate for Payer: United Healthcare HMO Rider |
$303.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$515.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.98
|
| Rate for Payer: Vantage Medical Group Senior |
$515.98
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
IP
|
$758.80
|
|
|
Service Code
|
NDC 59676-050-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$682.92 |
| Rate for Payer: Adventist Health Commercial |
$151.76
|
| Rate for Payer: Blue Shield of California Commercial |
$586.55
|
| Rate for Payer: Blue Shield of California EPN |
$382.44
|
| Rate for Payer: Cash Price |
$417.34
|
| Rate for Payer: Central Health Plan Commercial |
$607.04
|
| Rate for Payer: Cigna of CA HMO |
$531.16
|
| Rate for Payer: Cigna of CA PPO |
$531.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.52
|
| Rate for Payer: EPIC Health Plan Senior |
$303.52
|
| Rate for Payer: Galaxy Health WC |
$644.98
|
| Rate for Payer: Global Benefits Group Commercial |
$455.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$682.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.76
|
| Rate for Payer: Multiplan Commercial |
$569.10
|
| Rate for Payer: Networks By Design Commercial |
$493.22
|
| Rate for Payer: Prime Health Services Commercial |
$644.98
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
|
OP
|
$758.80
|
|
|
Service Code
|
NDC 59676-050-28
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$682.92 |
| Rate for Payer: Adventist Health Commercial |
$151.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$460.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$367.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.64
|
| Rate for Payer: Blue Shield of California Commercial |
$463.63
|
| Rate for Payer: Blue Shield of California EPN |
$302.76
|
| Rate for Payer: Cash Price |
$417.34
|
| Rate for Payer: Central Health Plan Commercial |
$607.04
|
| Rate for Payer: Cigna of CA HMO |
$531.16
|
| Rate for Payer: Cigna of CA PPO |
$531.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.52
|
| Rate for Payer: EPIC Health Plan Senior |
$303.52
|
| Rate for Payer: Galaxy Health WC |
$644.98
|
| Rate for Payer: Global Benefits Group Commercial |
$455.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$682.92
|
| Rate for Payer: InnovAge PACE Commercial |
$379.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.16
|
| Rate for Payer: Multiplan Commercial |
$569.10
|
| Rate for Payer: Networks By Design Commercial |
$493.22
|
| Rate for Payer: Prime Health Services Commercial |
$644.98
|
| Rate for Payer: Riverside University Health System MISP |
$303.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.40
|
| Rate for Payer: United Healthcare All Other HMO |
$379.40
|
| Rate for Payer: United Healthcare HMO Rider |
$379.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.98
|
| Rate for Payer: Vantage Medical Group Senior |
$644.98
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
IP
|
$921.20
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$829.08 |
| Rate for Payer: Adventist Health Commercial |
$184.24
|
| Rate for Payer: Blue Shield of California Commercial |
$712.09
|
| Rate for Payer: Blue Shield of California EPN |
$464.28
|
| Rate for Payer: Cash Price |
$506.66
|
| Rate for Payer: Central Health Plan Commercial |
$736.96
|
| Rate for Payer: Cigna of CA HMO |
$644.84
|
| Rate for Payer: Cigna of CA PPO |
$644.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.48
|
| Rate for Payer: EPIC Health Plan Senior |
$368.48
|
| Rate for Payer: Galaxy Health WC |
$783.02
|
| Rate for Payer: Global Benefits Group Commercial |
$552.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.24
|
| Rate for Payer: Multiplan Commercial |
$690.90
|
| Rate for Payer: Networks By Design Commercial |
$460.60
|
| Rate for Payer: Prime Health Services Commercial |
$783.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.73
|
| Rate for Payer: United Healthcare All Other HMO |
$336.51
|
| Rate for Payer: United Healthcare HMO Rider |
$329.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.69
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
OP
|
$921.20
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$829.08 |
| Rate for Payer: Adventist Health Commercial |
$184.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$783.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$446.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$541.02
|
| Rate for Payer: Blue Shield of California Commercial |
$562.85
|
| Rate for Payer: Blue Shield of California EPN |
$367.56
|
| Rate for Payer: Cash Price |
$506.66
|
| Rate for Payer: Central Health Plan Commercial |
$736.96
|
| Rate for Payer: Cigna of CA HMO |
$644.84
|
| Rate for Payer: Cigna of CA PPO |
$644.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$783.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$783.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$783.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.48
|
| Rate for Payer: EPIC Health Plan Senior |
$368.48
|
| Rate for Payer: Galaxy Health WC |
$783.02
|
| Rate for Payer: Global Benefits Group Commercial |
$552.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.08
|
| Rate for Payer: InnovAge PACE Commercial |
$460.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.84
|
| Rate for Payer: Multiplan Commercial |
$690.90
|
| Rate for Payer: Networks By Design Commercial |
$460.60
|
| Rate for Payer: Prime Health Services Commercial |
$783.02
|
| Rate for Payer: Riverside University Health System MISP |
$368.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.73
|
| Rate for Payer: United Healthcare All Other HMO |
$336.51
|
| Rate for Payer: United Healthcare HMO Rider |
$329.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$783.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$783.02
|
| Rate for Payer: Vantage Medical Group Senior |
$783.02
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: InnovAge PACE Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 42806-547-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: InnovAge PACE Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 50268-297-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: InnovAge PACE Commercial |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Riverside University Health System MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
