|
Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)
|
Facility
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 22845
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
1771241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Cash Price |
$25.14
|
| Rate for Payer: Central Health Plan Commercial |
$44.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
1771241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.01
|
| Rate for Payer: BCBS Transplant Transplant |
$33.52
|
| Rate for Payer: Blue Shield of California Commercial |
$35.14
|
| Rate for Payer: Blue Shield of California EPN |
$27.32
|
| Rate for Payer: Cash Price |
$25.14
|
| 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: EPIC Health Plan Commercial |
$22.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$41.90
|
| Rate for Payer: IEHP medi-cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.27
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.52
|
| Rate for Payer: Riverside University Health 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 |
$27.94
|
| Rate for Payer: United Healthcare All Other HMO |
$27.94
|
| Rate for Payer: United Healthcare HMO Rider |
$27.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Vantage Medical Group Senior |
$47.49
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX76368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX76368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Caremore Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.48
|
| Rate for Payer: IEHP medi-cal |
$2.49
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Innovage PACE Commercial |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Medicare |
$1.60
|
| Rate for Payer: Riverside University Health MISP |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 (400 VWF) UNIT/10 ML INTRAVENOUS SOLN [88337]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88337
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Caremore Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.21
|
| Rate for Payer: IEHP medi-cal |
$2.22
|
| Rate for Payer: IEHP Medicare Advantage |
$1.35
|
| Rate for Payer: Innovage PACE Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Medicare |
$1.43
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Caremore Medicare Advantage |
$1.30
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.13
|
| Rate for Payer: IEHP medi-cal |
$2.14
|
| Rate for Payer: IEHP Medicare Advantage |
$1.30
|
| Rate for Payer: Innovage PACE Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Medicare |
$1.37
|
| Rate for Payer: Riverside University Health MISP |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN [88338]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN [88338]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN [207372]
|
Facility
IP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX207372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,000 (800 VWF) UNIT/10 ML INTRAVENOUS SOLN [207372]
|
Facility
OP
|
$1.52
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX207372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
1720668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
1720668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Caremore Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.21
|
| Rate for Payer: IEHP medi-cal |
$2.22
|
| Rate for Payer: IEHP Medicare Advantage |
$1.35
|
| Rate for Payer: Innovage PACE Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Medicare |
$1.43
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
OP
|
$1.61
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$0.91
|
| Rate for Payer: BCBS Transplant Transplant |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1.20
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.97
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP medi-cal |
$1.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: IEHP Medicare Advantage |
$1.20
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Innovage PACE Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Prime Health Services Medicare |
$1.27
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| Rate for Payer: Riverside University Health MISP |
$1.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.81
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
IP
|
$1.61
|
|
|
Service Code
|
CPT J7186
|
| Hospital Charge Code |
ERX88336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Blue Shield of California Commercial |
$1.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Central Health Plan Commercial |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.93
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Caremore Medicare Advantage |
$1.30
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.13
|
| Rate for Payer: IEHP medi-cal |
$2.14
|
| Rate for Payer: IEHP Medicare Advantage |
$1.30
|
| Rate for Payer: Innovage PACE Commercial |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Medicare |
$1.37
|
| Rate for Payer: Riverside University Health MISP |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT J7183
|
| Hospital Charge Code |
ERX214026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.00
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
OP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Caremore Medicare Advantage |
$1.35
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.21
|
| Rate for Payer: IEHP medi-cal |
$2.22
|
| Rate for Payer: IEHP Medicare Advantage |
$1.35
|
| Rate for Payer: Innovage PACE Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Prime Health Services Medicare |
$1.43
|
| Rate for Payer: Riverside University Health MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
IP
|
$1.78
|
|
|
Service Code
|
CPT J7187
|
| Hospital Charge Code |
ERX70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$0.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Caremore Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Central Health Plan Commercial |
$1.77
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.48
|
| Rate for Payer: IEHP medi-cal |
$2.49
|
| Rate for Payer: IEHP Medicare Advantage |
$1.51
|
| Rate for Payer: Innovage PACE Commercial |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Medicare |
$1.60
|
| Rate for Payer: Riverside University Health MISP |
$1.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
