|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$115.45 |
| Rate for Payer: Blue Shield of California Commercial |
$96.21
|
| Rate for Payer: Blue Shield of California EPN |
$68.50
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Central Health Plan Commercial |
$102.62
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.66
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.44
|
| Rate for Payer: United Healthcare All Other HMO |
$47.31
|
| Rate for Payer: United Healthcare HMO Rider |
$46.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.33
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$115.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$76.97
|
| 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 |
$57.73
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Central Health Plan Commercial |
$102.62
|
| Rate for Payer: Cigna of CA HMO |
$89.80
|
| Rate for Payer: Cigna of CA PPO |
$89.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| 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 |
$109.04
|
| Rate for Payer: Global Benefits Group Commercial |
$76.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: InnovAge PACE Commercial |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.66
|
| 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 |
$96.21
|
| Rate for Payer: Networks By Design Commercial |
$64.14
|
| Rate for Payer: Prime Health Services Commercial |
$109.04
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health System MISP |
$9.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.14
|
| Rate for Payer: United Healthcare All Other HMO |
$64.14
|
| Rate for Payer: United Healthcare HMO Rider |
$64.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.14
|
| 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-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$119.12 |
| Rate for Payer: Blue Shield of California Commercial |
$99.27
|
| Rate for Payer: Blue Shield of California EPN |
$70.68
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Central Health Plan Commercial |
$105.89
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.94
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.98
|
| Rate for Payer: United Healthcare All Other HMO |
$48.81
|
| Rate for Payer: United Healthcare HMO Rider |
$47.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.68
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$119.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Blue Distinction Transplant |
$79.42
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Caremore Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Central Health Plan Commercial |
$105.89
|
| Rate for Payer: Cigna of CA HMO |
$92.65
|
| Rate for Payer: Cigna of CA PPO |
$92.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$112.51
|
| Rate for Payer: Global Benefits Group Commercial |
$79.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: Networks By Design Commercial |
$66.18
|
| Rate for Payer: Prime Health Services Commercial |
$112.51
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.18
|
| Rate for Payer: United Healthcare All Other HMO |
$66.18
|
| Rate for Payer: United Healthcare HMO Rider |
$66.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$238.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Blue Distinction Transplant |
$158.83
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Caremore Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Central Health Plan Commercial |
$211.78
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.36
|
| Rate for Payer: United Healthcare All Other HMO |
$132.36
|
| Rate for Payer: United Healthcare HMO Rider |
$132.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$238.25 |
| Rate for Payer: Blue Shield of California Commercial |
$198.54
|
| Rate for Payer: Blue Shield of California EPN |
$141.36
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Central Health Plan Commercial |
$211.78
|
| Rate for Payer: Cigna of CA HMO |
$185.30
|
| Rate for Payer: Cigna of CA PPO |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.89
|
| Rate for Payer: Galaxy Health WC |
$225.01
|
| Rate for Payer: Global Benefits Group Commercial |
$158.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.94
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: Networks By Design Commercial |
$132.36
|
| Rate for Payer: Prime Health Services Commercial |
$225.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.96
|
| Rate for Payer: United Healthcare All Other HMO |
$97.63
|
| Rate for Payer: United Healthcare HMO Rider |
$95.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.36
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Blue Distinction Transplant |
$15.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Caremore Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Central Health Plan Commercial |
$21.18
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: Networks By Design Commercial |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: Blue Shield of California Commercial |
$19.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.13
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Central Health Plan Commercial |
$21.18
|
| Rate for Payer: Cigna of CA HMO |
$18.53
|
| Rate for Payer: Cigna of CA PPO |
$18.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.59
|
| Rate for Payer: Galaxy Health WC |
$22.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: Networks By Design Commercial |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.74
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Blue Shield of California Commercial |
$29.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.21
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Central Health Plan Commercial |
$31.77
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.94
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.10
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Blue Distinction Transplant |
$23.83
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Caremore Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Central Health Plan Commercial |
$31.77
|
| Rate for Payer: Cigna of CA HMO |
$27.80
|
| Rate for Payer: Cigna of CA PPO |
$27.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$33.75
|
| Rate for Payer: Global Benefits Group Commercial |
$23.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$33.75
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.86
|
| Rate for Payer: United Healthcare All Other HMO |
$19.86
|
| Rate for Payer: United Healthcare HMO Rider |
$19.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
IP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$476.50 |
| Rate for Payer: Blue Shield of California Commercial |
$397.08
|
| Rate for Payer: Blue Shield of California EPN |
$282.72
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Central Health Plan Commercial |
$423.55
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.78
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.89
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.92
|
| Rate for Payer: United Healthcare All Other HMO |
$195.26
|
| Rate for Payer: United Healthcare HMO Rider |
$191.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.72
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$476.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Blue Distinction Transplant |
$317.66
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Caremore Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Central Health Plan Commercial |
$423.55
|
| Rate for Payer: Cigna of CA HMO |
$370.61
|
| Rate for Payer: Cigna of CA PPO |
$370.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$450.02
|
| Rate for Payer: Global Benefits Group Commercial |
$317.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$397.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: Networks By Design Commercial |
$264.72
|
| Rate for Payer: Prime Health Services Commercial |
$450.02
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.72
|
| Rate for Payer: United Healthcare HMO Rider |
$264.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Blue Distinction Transplant |
$31.76
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Caremore Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Central Health Plan Commercial |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Media |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$26.47
|
| Rate for Payer: United Healthcare HMO Rider |
$26.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Blue Shield of California Commercial |
$39.70
|
| Rate for Payer: Blue Shield of California EPN |
$28.27
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Central Health Plan Commercial |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$37.06
|
| Rate for Payer: Cigna of CA PPO |
$37.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.18
|
| Rate for Payer: Galaxy Health WC |
$45.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: Networks By Design Commercial |
$26.47
|
| Rate for Payer: Prime Health Services Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.99
|
| Rate for Payer: United Healthcare All Other HMO |
$19.52
|
| Rate for Payer: United Healthcare HMO Rider |
$19.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.47
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$59.02
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
NDC155307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$98.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.41
|
| Rate for Payer: Blue Distinction Transplant |
$35.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.31
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Central Health Plan Commercial |
$47.22
|
| Rate for Payer: Cigna of CA HMO |
$41.31
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.17
|
| Rate for Payer: Dignity Health Media |
$50.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.61
|
| Rate for Payer: Galaxy Health WC |
$50.17
|
| Rate for Payer: Global Benefits Group Commercial |
$35.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.26
|
| Rate for Payer: Networks By Design Commercial |
$29.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.17
|
| Rate for Payer: Riverside University Health System MISP |
$23.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.51
|
| Rate for Payer: United Healthcare All Other HMO |
$29.51
|
| Rate for Payer: United Healthcare HMO Rider |
$29.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.17
|
| Rate for Payer: Vantage Medical Group Senior |
$50.17
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$53.40
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1771290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$98.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.41
|
| Rate for Payer: Blue Distinction Transplant |
$32.04
|
| Rate for Payer: Blue Shield of California Commercial |
$19.31
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Central Health Plan Commercial |
$42.72
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Media |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.05
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: Riverside University Health System MISP |
$21.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.70
|
| Rate for Payer: United Healthcare All Other HMO |
$26.70
|
| Rate for Payer: United Healthcare HMO Rider |
$26.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$53.40
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1771290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Blue Shield of California Commercial |
$40.05
|
| Rate for Payer: Blue Shield of California EPN |
$28.52
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Central Health Plan Commercial |
$42.72
|
| Rate for Payer: Cigna of CA HMO |
$37.38
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.36
|
| Rate for Payer: Galaxy Health WC |
$45.39
|
| Rate for Payer: Global Benefits Group Commercial |
$32.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.05
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.16
|
| Rate for Payer: United Healthcare All Other HMO |
$19.69
|
| Rate for Payer: United Healthcare HMO Rider |
$19.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.62
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$59.02
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
NDC155307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California EPN |
$31.52
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Central Health Plan Commercial |
$47.22
|
| Rate for Payer: Cigna of CA HMO |
$41.31
|
| Rate for Payer: Cigna of CA PPO |
$41.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.61
|
| Rate for Payer: Galaxy Health WC |
$50.17
|
| Rate for Payer: Global Benefits Group Commercial |
$35.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.26
|
| Rate for Payer: Networks By Design Commercial |
$29.51
|
| Rate for Payer: Prime Health Services Commercial |
$50.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.29
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$98.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.41
|
| Rate for Payer: Blue Distinction Transplant |
$13.46
|
| Rate for Payer: Blue Shield of California Commercial |
$19.31
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Central Health Plan Commercial |
$17.94
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Media |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: Networks By Design Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: Riverside University Health System MISP |
$8.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other HMO |
$11.22
|
| Rate for Payer: United Healthcare HMO Rider |
$11.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.19 |
| Rate for Payer: Blue Shield of California Commercial |
$16.82
|
| Rate for Payer: Blue Shield of California EPN |
$11.98
|
| Rate for Payer: Cash Price |
$10.09
|
| Rate for Payer: Central Health Plan Commercial |
$17.94
|
| Rate for Payer: Cigna of CA HMO |
$15.70
|
| Rate for Payer: Cigna of CA PPO |
$15.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.07
|
| Rate for Payer: Global Benefits Group Commercial |
$13.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: Networks By Design Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.47
|
| Rate for Payer: United Healthcare All Other HMO |
$8.27
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.40
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Blue Shield of California Commercial |
$40.63
|
| Rate for Payer: Blue Shield of California EPN |
$28.93
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Central Health Plan Commercial |
$43.34
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$40.63
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.45
|
| Rate for Payer: United Healthcare All Other HMO |
$19.98
|
| Rate for Payer: United Healthcare HMO Rider |
$19.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
CPT J1325
|
| Hospital Charge Code |
1759954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$98.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.41
|
| Rate for Payer: Blue Distinction Transplant |
$32.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.31
|
| Rate for Payer: Blue Shield of California EPN |
$17.55
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Central Health Plan Commercial |
$43.34
|
| Rate for Payer: Cigna of CA HMO |
$37.92
|
| Rate for Payer: Cigna of CA PPO |
$37.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Media |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$46.04
|
| Rate for Payer: Global Benefits Group Commercial |
$32.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$40.63
|
| Rate for Payer: Networks By Design Commercial |
$27.08
|
| Rate for Payer: Prime Health Services Commercial |
$46.04
|
| Rate for Payer: Riverside University Health System MISP |
$21.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.08
|
| Rate for Payer: United Healthcare All Other HMO |
$27.08
|
| Rate for Payer: United Healthcare HMO Rider |
$27.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
CPT J1327
|
| Hospital Charge Code |
1722021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Blue Shield of California Commercial |
$2.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
CPT J1327
|
| Hospital Charge Code |
1722021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$275.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.84
|
| Rate for Payer: Blue Distinction Transplant |
$0.72
|
| Rate for Payer: Blue Distinction Transplant |
$1.80
|
| Rate for Payer: Blue Distinction Transplant |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$35.72
|
| Rate for Payer: Blue Shield of California Commercial |
$35.72
|
| Rate for Payer: Blue Shield of California Commercial |
$35.72
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.47
|
| Rate for Payer: Caremore Medicare Advantage |
$3.35
|
| Rate for Payer: Caremore Medicare Advantage |
$3.35
|
| Rate for Payer: Caremore Medicare Advantage |
$3.35
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Media |
$3.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.35
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.35
|
| Rate for Payer: InnovAge PACE Commercial |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Prime Health Services Medicare |
$3.55
|
| Rate for Payer: Prime Health Services Medicare |
$3.55
|
| Rate for Payer: Prime Health Services Medicare |
$3.55
|
| Rate for Payer: Riverside University Health System MISP |
$3.68
|
| Rate for Payer: Riverside University Health System MISP |
$3.68
|
| Rate for Payer: Riverside University Health System MISP |
$3.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1722020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Blue Distinction Transplant |
$6.77
|
| Rate for Payer: Blue Distinction Transplant |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Media |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Riverside University Health System MISP |
$4.51
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
