|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$0.92
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$1.69
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.54
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| 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 |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Central Health Plan Commercial |
$1.94
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Senior |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.58
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Medicare |
$1.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.65
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.45
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.65
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Medicare |
$2.60
|
| Rate for Payer: Riverside University Health System MISP |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.65
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.45
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.65
|
| Rate for Payer: Cigna of CA HMO |
$2.32
|
| Rate for Payer: Cigna of CA PPO |
$2.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.45
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Medicare |
$2.60
|
| Rate for Payer: Riverside University Health System MISP |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.21
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Central Health Plan Commercial |
$4.41
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA PPO |
$3.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Networks By Design Commercial |
$2.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.17
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Medicare |
$4.42
|
| Rate for Payer: Riverside University Health System MISP |
$4.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Central Health Plan Commercial |
$4.41
|
| Rate for Payer: Cigna of CA HMO |
$3.86
|
| Rate for Payer: Cigna of CA PPO |
$3.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Networks By Design Commercial |
$2.75
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
IP
|
$1,376.95
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.39 |
| Max. Negotiated Rate |
$1,239.26 |
| Rate for Payer: Adventist Health Commercial |
$275.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,104.31
|
| Rate for Payer: Blue Shield of California EPN |
$693.98
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Central Health Plan Commercial |
$1,101.56
|
| Rate for Payer: Cigna of CA HMO |
$963.87
|
| Rate for Payer: Cigna of CA PPO |
$963.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$963.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.78
|
| Rate for Payer: EPIC Health Plan Senior |
$550.78
|
| Rate for Payer: Galaxy Health WC |
$1,170.41
|
| Rate for Payer: Global Benefits Group Commercial |
$826.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,239.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$874.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$812.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.39
|
| Rate for Payer: Multiplan Commercial |
$1,032.71
|
| Rate for Payer: Networks By Design Commercial |
$688.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,170.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.77
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$492.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.95
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
OP
|
$1,376.95
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.39 |
| Max. Negotiated Rate |
$5,821.18 |
| Rate for Payer: Adventist Health Commercial |
$275.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,057.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,821.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,586.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,163.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,057.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$485.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,407.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,279.39
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Central Health Plan Commercial |
$1,101.56
|
| Rate for Payer: Cigna of CA HMO |
$963.87
|
| Rate for Payer: Cigna of CA PPO |
$963.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,163.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,163.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$963.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1,163.57
|
| Rate for Payer: Galaxy Health WC |
$1,170.41
|
| Rate for Payer: Global Benefits Group Commercial |
$826.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,239.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,734.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,057.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,057.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$874.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$499.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,480.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,417.44
|
| Rate for Payer: Multiplan Commercial |
$1,032.71
|
| Rate for Payer: Networks By Design Commercial |
$688.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,057.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,170.41
|
| Rate for Payer: Prime Health Services Medicare |
$1,121.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,163.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$826.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.77
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$492.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,057.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,163.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1,163.57
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) 120 MG SOLUTION FOR INJECTION [222871]
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$9,357.80 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,466.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$871.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,414.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,013.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,742.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,584.00
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,267.20
|
| Rate for Payer: Cigna of CA HMO |
$1,108.80
|
| Rate for Payer: Cigna of CA PPO |
$1,108.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,346.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,346.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$633.60
|
| Rate for Payer: EPIC Health Plan Senior |
$633.60
|
| Rate for Payer: Galaxy Health WC |
$1,346.40
|
| Rate for Payer: Global Benefits Group Commercial |
$950.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,425.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,471.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,005.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,357.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$934.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,108.80
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: Networks By Design Commercial |
$792.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,346.40
|
| Rate for Payer: Riverside University Health System MISP |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$950.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$950.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$594.48
|
| Rate for Payer: United Healthcare All Other HMO |
$578.64
|
| Rate for Payer: United Healthcare HMO Rider |
$566.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,346.40
|
|
