|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
OP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$78.63 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Central Health Plan Commercial |
$69.90
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Senior |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.57
|
| Rate for Payer: InnovAge PACE Commercial |
$43.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.16
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: Networks By Design Commercial |
$43.69
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Riverside University Health System MISP |
$34.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$31.92
|
| Rate for Payer: United Healthcare HMO Rider |
$31.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
IP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$78.63 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Blue Shield of California Commercial |
$67.54
|
| Rate for Payer: Blue Shield of California EPN |
$44.03
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Central Health Plan Commercial |
$69.90
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Senior |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: Networks By Design Commercial |
$43.69
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$31.92
|
| Rate for Payer: United Healthcare HMO Rider |
$31.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.61
|
|
|
AMPICILLIN-SULBACTAM 3 G/100 ML IN NS [400006]
|
Facility
|
IP
|
$86.08
|
|
|
Service Code
|
NDC 9940-8203-96
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Central Health Plan Commercial |
$68.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.43
|
| Rate for Payer: EPIC Health Plan Senior |
$34.43
|
| Rate for Payer: Galaxy Health WC |
$73.17
|
| Rate for Payer: Global Benefits Group Commercial |
$51.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$64.56
|
| Rate for Payer: Networks By Design Commercial |
$55.95
|
| Rate for Payer: Prime Health Services Commercial |
$73.17
|
|
|
AMPICILLIN-SULBACTAM 3 G/100 ML IN NS [400006]
|
Facility
|
OP
|
$86.08
|
|
|
Service Code
|
NDC 9940-8203-96
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.55
|
| Rate for Payer: Blue Shield of California Commercial |
$52.59
|
| Rate for Payer: Blue Shield of California EPN |
$34.35
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Central Health Plan Commercial |
$68.86
|
| Rate for Payer: Cigna of CA HMO |
$55.09
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.43
|
| Rate for Payer: EPIC Health Plan Senior |
$34.43
|
| Rate for Payer: Galaxy Health WC |
$73.17
|
| Rate for Payer: Global Benefits Group Commercial |
$51.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.47
|
| Rate for Payer: InnovAge PACE Commercial |
$43.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.26
|
| Rate for Payer: Multiplan Commercial |
$64.56
|
| Rate for Payer: Networks By Design Commercial |
$55.95
|
| Rate for Payer: Prime Health Services Commercial |
$73.17
|
| Rate for Payer: Riverside University Health System MISP |
$34.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.04
|
| Rate for Payer: United Healthcare HMO Rider |
$43.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.17
|
| Rate for Payer: Vantage Medical Group Senior |
$73.17
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
OP
|
$17.47
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.57
|
| Rate for Payer: InnovAge PACE Commercial |
$8.73
|
| Rate for Payer: InnovAge PACE Commercial |
$3.18
|
| Rate for Payer: InnovAge PACE Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Riverside University Health System MISP |
$2.57
|
| Rate for Payer: Riverside University Health System MISP |
$2.54
|
| Rate for Payer: Riverside University Health System MISP |
$6.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
IP
|
$6.43
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4.92
|
| Rate for Payer: Blue Shield of California Commercial |
$13.50
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Central Health Plan Commercial |
$5.14
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: InnovAge PACE Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$377.35
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$339.62 |
| Rate for Payer: Adventist Health Commercial |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$291.69
|
| Rate for Payer: Blue Shield of California EPN |
$190.18
|
| Rate for Payer: Cash Price |
$207.54
|
| Rate for Payer: Central Health Plan Commercial |
$301.88
|
| Rate for Payer: Cigna of CA HMO |
$264.14
|
| Rate for Payer: Cigna of CA PPO |
$264.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.94
|
| Rate for Payer: EPIC Health Plan Senior |
$150.94
|
| Rate for Payer: Galaxy Health WC |
$320.75
|
| Rate for Payer: Global Benefits Group Commercial |
$226.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.47
|
| Rate for Payer: Multiplan Commercial |
$283.01
|
| Rate for Payer: Networks By Design Commercial |
$188.68
|
| Rate for Payer: Prime Health Services Commercial |
$320.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.62
|
| Rate for Payer: United Healthcare All Other HMO |
$137.85
|
| Rate for Payer: United Healthcare HMO Rider |
$134.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.58
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$377.35
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$339.62 |
| Rate for Payer: Adventist Health Commercial |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.62
|
| Rate for Payer: Blue Shield of California Commercial |
$230.56
|
| Rate for Payer: Blue Shield of California EPN |
$150.56
|
| Rate for Payer: Cash Price |
$207.54
|
| Rate for Payer: Central Health Plan Commercial |
$301.88
|
| Rate for Payer: Cigna of CA HMO |
$264.14
|
| Rate for Payer: Cigna of CA PPO |
$264.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.94
|
| Rate for Payer: EPIC Health Plan Senior |
$150.94
|
| Rate for Payer: Galaxy Health WC |
$320.75
|
| Rate for Payer: Global Benefits Group Commercial |
$226.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.62
|
| Rate for Payer: InnovAge PACE Commercial |
$188.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.14
|
| Rate for Payer: Multiplan Commercial |
$283.01
|
| Rate for Payer: Networks By Design Commercial |
$188.68
|
| Rate for Payer: Prime Health Services Commercial |
$320.75
|
| Rate for Payer: Riverside University Health System MISP |
$150.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.62
|
| Rate for Payer: United Healthcare All Other HMO |
$137.85
|
| Rate for Payer: United Healthcare HMO Rider |
$134.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.75
|
| Rate for Payer: Vantage Medical Group Senior |
$320.75
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: InnovAge PACE Commercial |
$0.18
|
| Rate for Payer: InnovAge PACE Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Riverside University Health System MISP |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$206.16 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Blue Shield of California Commercial |
$177.07
|
| Rate for Payer: Blue Shield of California EPN |
$115.45
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Central Health Plan Commercial |
$183.26
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.81
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$206.16 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Central Health Plan Commercial |
$183.26
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.47
|
| Rate for Payer: InnovAge PACE Commercial |
$114.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: Riverside University Health System MISP |
$91.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.81
|
| Rate for Payer: Blue Shield of California Commercial |
$34.14
|
| Rate for Payer: Blue Shield of California EPN |
$22.29
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Central Health Plan Commercial |
$44.70
|
| Rate for Payer: Cigna of CA HMO |
$35.76
|
| Rate for Payer: Cigna of CA PPO |
$41.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.28
|
| Rate for Payer: InnovAge PACE Commercial |
$27.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.11
|
| Rate for Payer: Multiplan Commercial |
$41.90
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
| Rate for Payer: Riverside University Health System MISP |
$22.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.93
|
| Rate for Payer: United Healthcare All Other HMO |
$27.93
|
| Rate for Payer: United Healthcare HMO Rider |
$27.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Vantage Medical Group Senior |
$47.49
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Central Health Plan Commercial |
$44.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$47.49
|
| Rate for Payer: Global Benefits Group Commercial |
$33.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$41.90
|
| Rate for Payer: Networks By Design Commercial |
$36.32
|
| Rate for Payer: Prime Health Services Commercial |
$47.49
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$1.88
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Senior |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$1.88
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.07
|
| Rate for Payer: EPIC Health Plan Senior |
$1.53
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.53
|
| Rate for Payer: InnovAge PACE Commercial |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: Prime Health Services Medicare |
$1.63
|
| Rate for Payer: Riverside University Health System MISP |
$1.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: InnovAge PACE Commercial |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.49
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Medicare |
$1.58
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Central Health Plan Commercial |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.72
|
| Rate for Payer: EPIC Health Plan Senior |
$1.27
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.27
|
| Rate for Payer: InnovAge PACE Commercial |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.27
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: Prime Health Services Medicare |
$1.35
|
| Rate for Payer: Riverside University Health System MISP |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Central Health Plan Commercial |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: EPIC Health Plan Senior |
$0.84
|
| Rate for Payer: Galaxy Health WC |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: InnovAge PACE Commercial |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.49
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Medicare |
$1.58
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$1.39
|
| Rate for Payer: Cigna of CA PPO |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.68
|
| Rate for Payer: Global Benefits Group Commercial |
$1.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS J7186
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: EPIC Health Plan Senior |
$1.23
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.23
|
| Rate for Payer: InnovAge PACE Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Prime Health Services Medicare |
$1.30
|
| Rate for Payer: Riverside University Health System MISP |
$1.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
