|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
IP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
OP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$7.92
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 25450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION [88009]
|
Facility
IP
|
$2.32
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
NDG88009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.97
|
|
|
EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION [88009]
|
Facility
OP
|
$2.32
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
NDG88009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Central Health Plan Commercial |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.93
|
| Rate for Payer: Galaxy Health WC |
$1.97
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.74
|
| Rate for Payer: IEHP medi-cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.97
|
| Rate for Payer: Riverside University Health MISP |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other HMO |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.97
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
1755705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Blue Shield of California Commercial |
$1.68
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
OP
|
$2.24
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
1755705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Central Health Plan Commercial |
$1.79
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.68
|
| Rate for Payer: IEHP medi-cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.90
|
| Rate for Payer: Riverside University Health MISP |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]
|
Facility
IP
|
$46.25
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
ERX76923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Blue Shield of California Commercial |
$34.69
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Central Health Plan Commercial |
$37.00
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$32.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.50
|
| Rate for Payer: Galaxy Health WC |
$39.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Multiplan Commercial |
$34.69
|
| Rate for Payer: Networks By Design Commercial |
$23.12
|
| Rate for Payer: Prime Health Services Commercial |
$39.31
|
|
|
EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]
|
Facility
OP
|
$46.25
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
ERX76923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.46
|
| Rate for Payer: BCBS Transplant Transplant |
$27.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Central Health Plan Commercial |
$37.00
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$32.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.50
|
| Rate for Payer: Galaxy Health WC |
$39.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.69
|
| Rate for Payer: IEHP medi-cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Multiplan Commercial |
$34.69
|
| Rate for Payer: Networks By Design Commercial |
$23.12
|
| Rate for Payer: Prime Health Services Commercial |
$39.31
|
| Rate for Payer: Riverside University Health MISP |
$18.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.12
|
| Rate for Payer: United Healthcare All Other HMO |
$23.12
|
| Rate for Payer: United Healthcare HMO Rider |
$23.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$39.31
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: IEHP medi-cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Riverside University Health MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
| Rate for Payer: BCBS Transplant Transplant |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.26
|
| Rate for Payer: IEHP medi-cal |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: Riverside University Health MISP |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
IP
|
$320.70
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.14 |
| Max. Negotiated Rate |
$288.63 |
| Rate for Payer: Blue Shield of California Commercial |
$240.52
|
| Rate for Payer: Blue Shield of California Commercial |
$240.52
|
| Rate for Payer: Blue Shield of California Commercial |
$149.22
|
| Rate for Payer: Blue Shield of California EPN |
$171.25
|
| Rate for Payer: Blue Shield of California EPN |
$106.24
|
| Rate for Payer: Blue Shield of California EPN |
$171.25
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Central Health Plan Commercial |
$256.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.17
|
| Rate for Payer: Central Health Plan Commercial |
$256.56
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.28
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.14
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
OP
|
$320.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$288.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$192.41
|
| Rate for Payer: BCBS Transplant Transplant |
$192.42
|
| Rate for Payer: BCBS Transplant Transplant |
$119.38
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Central Health Plan Commercial |
$256.55
|
| Rate for Payer: Central Health Plan Commercial |
$159.17
|
| Rate for Payer: Central Health Plan Commercial |
$256.56
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$240.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$240.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.35
|
| Rate for Payer: United Healthcare All Other HMO |
$160.35
|
| Rate for Payer: United Healthcare All Other HMO |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$160.34
|
| Rate for Payer: United Healthcare HMO Rider |
$99.48
|
| Rate for Payer: United Healthcare HMO Rider |
$160.35
|
| Rate for Payer: United Healthcare HMO Rider |
$160.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
OP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$119.38
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Central Health Plan Commercial |
$159.17
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.48
|
| Rate for Payer: United Healthcare All Other HMO |
$99.48
|
| Rate for Payer: United Healthcare HMO Rider |
$99.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$179.06 |
| Rate for Payer: Blue Shield of California Commercial |
$149.22
|
| Rate for Payer: Blue Shield of California EPN |
$106.24
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Central Health Plan Commercial |
$159.17
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.79
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
IP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.28 |
| Max. Negotiated Rate |
$577.26 |
| Rate for Payer: Blue Shield of California Commercial |
$481.05
|
| Rate for Payer: Blue Shield of California EPN |
$342.51
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Central Health Plan Commercial |
$513.12
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$256.56
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$577.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.28
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
OP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$577.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$384.84
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Central Health Plan Commercial |
$513.12
|
| Rate for Payer: Cigna of CA HMO |
$448.98
|
| Rate for Payer: Cigna of CA PPO |
$448.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$545.19
|
| Rate for Payer: Global Benefits Group Commercial |
$384.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$577.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$481.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: Networks By Design Commercial |
$320.70
|
| Rate for Payer: Prime Health Services Commercial |
$545.19
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.70
|
| Rate for Payer: United Healthcare All Other HMO |
$320.70
|
| Rate for Payer: United Healthcare HMO Rider |
$320.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
IP
|
$64.15
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Blue Shield of California Commercial |
$48.11
|
| Rate for Payer: Blue Shield of California Commercial |
$29.84
|
| Rate for Payer: Blue Shield of California EPN |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$34.26
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Central Health Plan Commercial |
$31.83
|
| Rate for Payer: Central Health Plan Commercial |
$51.32
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA HMO |
$44.90
|
| Rate for Payer: Cigna of CA PPO |
$44.90
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.92
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: Networks By Design Commercial |
$19.90
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
OP
|
$39.79
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$35.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$23.87
|
| Rate for Payer: BCBS Transplant Transplant |
$38.49
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Central Health Plan Commercial |
$31.83
|
| Rate for Payer: Central Health Plan Commercial |
$51.32
|
| Rate for Payer: Cigna of CA HMO |
$27.85
|
| Rate for Payer: Cigna of CA HMO |
$44.90
|
| Rate for Payer: Cigna of CA PPO |
$27.85
|
| Rate for Payer: Cigna of CA PPO |
$44.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$54.53
|
| Rate for Payer: Galaxy Health WC |
$33.82
|
| Rate for Payer: Global Benefits Group Commercial |
$23.87
|
| Rate for Payer: Global Benefits Group Commercial |
$38.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$19.90
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$33.82
|
| Rate for Payer: Prime Health Services Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$32.08
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
IP
|
$59.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$53.72 |
| Rate for Payer: Blue Shield of California Commercial |
$44.77
|
| Rate for Payer: Blue Shield of California Commercial |
$72.16
|
| Rate for Payer: Blue Shield of California EPN |
$51.38
|
| Rate for Payer: Blue Shield of California EPN |
$31.87
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: Central Health Plan Commercial |
$47.75
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.88
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.16
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
OP
|
$96.22
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$35.81
|
| Rate for Payer: BCBS Transplant Transplant |
$57.73
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: Central Health Plan Commercial |
$47.75
|
| Rate for Payer: Cigna of CA HMO |
$67.35
|
| Rate for Payer: Cigna of CA HMO |
$41.78
|
| Rate for Payer: Cigna of CA PPO |
$67.35
|
| Rate for Payer: Cigna of CA PPO |
$41.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Galaxy Health WC |
$50.74
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Global Benefits Group Commercial |
$35.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.16
|
| Rate for Payer: Networks By Design Commercial |
$48.11
|
| Rate for Payer: Networks By Design Commercial |
$29.84
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Commercial |
$50.74
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.11
|
| Rate for Payer: United Healthcare All Other HMO |
$29.84
|
| Rate for Payer: United Healthcare HMO Rider |
$29.84
|
| Rate for Payer: United Healthcare HMO Rider |
$48.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
IP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.56 |
| Max. Negotiated Rate |
$1,154.52 |
| Rate for Payer: Blue Shield of California Commercial |
$962.10
|
| Rate for Payer: Blue Shield of California EPN |
$685.02
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Central Health Plan Commercial |
$1,026.24
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$513.12
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,154.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$962.10
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
OP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$1,154.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: BCBS Transplant Transplant |
$769.68
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$19.90
|
| Rate for Payer: Caremore Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Central Health Plan Commercial |
$1,026.24
|
| Rate for Payer: Cigna of CA HMO |
$897.96
|
| Rate for Payer: Cigna of CA PPO |
$897.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$1,090.38
|
| Rate for Payer: Global Benefits Group Commercial |
$769.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,154.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$962.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: IEHP medi-cal |
$14.66
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Innovage PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$962.10
|
| Rate for Payer: Networks By Design Commercial |
$641.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.38
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other HMO |
$641.40
|
| Rate for Payer: United Healthcare HMO Rider |
$641.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
