|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
OP
|
$5.40
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
1722020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: BCBS Transplant Transplant |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| 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: Cash Price |
$5.08
|
| Rate for Payer: Cash Price |
$2.43
|
| 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 |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| 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: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| 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 Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.46
|
| Rate for Payer: IEHP medi-cal |
$1.89
|
| Rate for Payer: 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 MISP |
$4.51
|
| Rate for Payer: Riverside University Health MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| 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 |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION [23124]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
NDG23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
OP
|
$68.40
|
|
|
Service Code
|
CPT J0122
|
| Hospital Charge Code |
ERX222798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.13
|
| Rate for Payer: BCBS Transplant Transplant |
$41.04
|
| Rate for Payer: Blue Shield of California Commercial |
$43.02
|
| Rate for Payer: Blue Shield of California EPN |
$33.45
|
| Rate for Payer: Caremore Medicare Advantage |
$1.48
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Central Health Plan Commercial |
$54.72
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.43
|
| Rate for Payer: IEHP medi-cal |
$2.44
|
| Rate for Payer: IEHP Medicare Advantage |
$1.48
|
| Rate for Payer: Innovage PACE Commercial |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: Prime Health Services Medicare |
$1.57
|
| Rate for Payer: Riverside University Health MISP |
$1.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.20
|
| Rate for Payer: United Healthcare All Other HMO |
$34.20
|
| Rate for Payer: United Healthcare HMO Rider |
$34.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$1.48
|
|
|
ERAVACYCLINE 50 MG INTRAVENOUS SOLUTION [222798]
|
Facility
IP
|
$68.40
|
|
|
Service Code
|
CPT J0122
|
| Hospital Charge Code |
ERX222798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Blue Shield of California Commercial |
$51.30
|
| Rate for Payer: Blue Shield of California EPN |
$36.53
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Central Health Plan Commercial |
$54.72
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
OP
|
$403.73
|
|
|
Service Code
|
NDC 59676-030-56
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$363.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$245.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$343.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$222.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$222.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.52
|
| Rate for Payer: BCBS Transplant Transplant |
$242.24
|
| Rate for Payer: Blue Shield of California Commercial |
$253.95
|
| Rate for Payer: Blue Shield of California EPN |
$197.42
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Central Health Plan Commercial |
$322.98
|
| Rate for Payer: Cigna of CA HMO |
$282.61
|
| Rate for Payer: Cigna of CA PPO |
$282.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.49
|
| Rate for Payer: Galaxy Health WC |
$343.17
|
| Rate for Payer: Global Benefits Group Commercial |
$242.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$302.80
|
| Rate for Payer: IEHP medi-cal |
$141.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Multiplan Commercial |
$302.80
|
| Rate for Payer: Networks By Design Commercial |
$201.86
|
| Rate for Payer: Prime Health Services Commercial |
$343.17
|
| Rate for Payer: Riverside University Health MISP |
$161.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.86
|
| Rate for Payer: United Healthcare All Other HMO |
$201.86
|
| Rate for Payer: United Healthcare HMO Rider |
$201.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.17
|
| Rate for Payer: Vantage Medical Group Senior |
$343.17
|
|
|
ERDAFITINIB 3 MG TABLET [224623]
|
Facility
IP
|
$403.73
|
|
|
Service Code
|
NDC 59676-030-56
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$363.36 |
| Rate for Payer: Blue Shield of California Commercial |
$302.80
|
| Rate for Payer: Blue Shield of California EPN |
$215.59
|
| Rate for Payer: Cash Price |
$181.68
|
| Rate for Payer: Central Health Plan Commercial |
$322.98
|
| Rate for Payer: Cigna of CA HMO |
$282.61
|
| Rate for Payer: Cigna of CA PPO |
$282.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$161.49
|
| Rate for Payer: Galaxy Health WC |
$343.17
|
| Rate for Payer: Global Benefits Group Commercial |
$242.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Multiplan Commercial |
$302.80
|
| Rate for Payer: Networks By Design Commercial |
$201.86
|
| Rate for Payer: Prime Health Services Commercial |
$343.17
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
OP
|
$538.30
|
|
|
Service Code
|
NDC 59676-040-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.66 |
| Max. Negotiated Rate |
$484.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$326.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$296.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$296.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$260.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.03
|
| Rate for Payer: BCBS Transplant Transplant |
$322.98
|
| Rate for Payer: Blue Shield of California Commercial |
$338.59
|
| Rate for Payer: Blue Shield of California EPN |
$263.23
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Central Health Plan Commercial |
$430.64
|
| Rate for Payer: Cigna of CA HMO |
$376.81
|
| Rate for Payer: Cigna of CA PPO |
$376.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.32
|
| Rate for Payer: Galaxy Health WC |
$457.56
|
| Rate for Payer: Global Benefits Group Commercial |
$322.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$403.72
|
| Rate for Payer: IEHP medi-cal |
$188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.66
|
| Rate for Payer: Multiplan Commercial |
$403.72
|
| Rate for Payer: Networks By Design Commercial |
$269.15
|
| Rate for Payer: Prime Health Services Commercial |
$457.56
|
| Rate for Payer: Riverside University Health MISP |
$215.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.15
|
| Rate for Payer: United Healthcare All Other HMO |
$269.15
|
| Rate for Payer: United Healthcare HMO Rider |
$269.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$457.56
|
| Rate for Payer: Vantage Medical Group Senior |
$457.56
|
|
|
ERDAFITINIB 4 MG TABLET [224624]
|
Facility
IP
|
$538.30
|
|
|
Service Code
|
NDC 59676-040-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.66 |
| Max. Negotiated Rate |
$484.47 |
| Rate for Payer: Blue Shield of California Commercial |
$403.72
|
| Rate for Payer: Blue Shield of California EPN |
$287.45
|
| Rate for Payer: Cash Price |
$242.24
|
| Rate for Payer: Central Health Plan Commercial |
$430.64
|
| Rate for Payer: Cigna of CA HMO |
$376.81
|
| Rate for Payer: Cigna of CA PPO |
$376.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.32
|
| Rate for Payer: Galaxy Health WC |
$457.56
|
| Rate for Payer: Global Benefits Group Commercial |
$322.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.66
|
| Rate for Payer: Multiplan Commercial |
$403.72
|
| Rate for Payer: Networks By Design Commercial |
$269.15
|
| Rate for Payer: Prime Health Services Commercial |
$457.56
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
OP
|
$672.88
|
|
|
Service Code
|
NDC 59676-050-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.58 |
| Max. Negotiated Rate |
$605.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$408.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$571.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$370.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$325.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.54
|
| Rate for Payer: BCBS Transplant Transplant |
$403.73
|
| Rate for Payer: Blue Shield of California Commercial |
$423.24
|
| Rate for Payer: Blue Shield of California EPN |
$329.04
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Central Health Plan Commercial |
$538.30
|
| Rate for Payer: Cigna of CA HMO |
$471.02
|
| Rate for Payer: Cigna of CA PPO |
$471.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.15
|
| Rate for Payer: Galaxy Health WC |
$571.95
|
| Rate for Payer: Global Benefits Group Commercial |
$403.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$504.66
|
| Rate for Payer: IEHP medi-cal |
$235.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.58
|
| Rate for Payer: Multiplan Commercial |
$504.66
|
| Rate for Payer: Networks By Design Commercial |
$336.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.95
|
| Rate for Payer: Riverside University Health MISP |
$269.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$403.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$403.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$336.44
|
| Rate for Payer: United Healthcare All Other HMO |
$336.44
|
| Rate for Payer: United Healthcare HMO Rider |
$336.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$336.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$571.95
|
| Rate for Payer: Vantage Medical Group Senior |
$571.95
|
|
|
ERDAFITINIB 5 MG TABLET [224625]
|
Facility
IP
|
$672.88
|
|
|
Service Code
|
NDC 59676-050-28
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.58 |
| Max. Negotiated Rate |
$605.59 |
| Rate for Payer: Blue Shield of California Commercial |
$504.66
|
| Rate for Payer: Blue Shield of California EPN |
$359.32
|
| Rate for Payer: Cash Price |
$302.80
|
| Rate for Payer: Central Health Plan Commercial |
$538.30
|
| Rate for Payer: Cigna of CA HMO |
$471.02
|
| Rate for Payer: Cigna of CA PPO |
$471.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$269.15
|
| Rate for Payer: Galaxy Health WC |
$571.95
|
| Rate for Payer: Global Benefits Group Commercial |
$403.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$605.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$448.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.58
|
| Rate for Payer: Multiplan Commercial |
$504.66
|
| Rate for Payer: Networks By Design Commercial |
$336.44
|
| Rate for Payer: Prime Health Services Commercial |
$571.95
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
IP
|
$885.43
|
|
|
Service Code
|
CPT J3590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.09 |
| Max. Negotiated Rate |
$796.89 |
| Rate for Payer: Blue Shield of California Commercial |
$664.07
|
| Rate for Payer: Blue Shield of California EPN |
$472.82
|
| Rate for Payer: Cash Price |
$398.44
|
| Rate for Payer: Central Health Plan Commercial |
$708.34
|
| Rate for Payer: Cigna of CA HMO |
$619.80
|
| Rate for Payer: Cigna of CA PPO |
$619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$354.17
|
| Rate for Payer: Galaxy Health WC |
$752.62
|
| Rate for Payer: Global Benefits Group Commercial |
$531.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$796.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.09
|
| Rate for Payer: Multiplan Commercial |
$664.07
|
| Rate for Payer: Networks By Design Commercial |
$442.72
|
| Rate for Payer: Prime Health Services Commercial |
$752.62
|
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
OP
|
$885.43
|
|
|
Service Code
|
CPT J3590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.09 |
| Max. Negotiated Rate |
$796.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$537.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$752.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$486.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$486.99
|
| Rate for Payer: BCBS Transplant Transplant |
$531.26
|
| Rate for Payer: Blue Shield of California Commercial |
$556.94
|
| Rate for Payer: Blue Shield of California EPN |
$432.98
|
| Rate for Payer: Cash Price |
$398.44
|
| Rate for Payer: Cash Price |
$398.44
|
| Rate for Payer: Central Health Plan Commercial |
$708.34
|
| Rate for Payer: Cigna of CA HMO |
$619.80
|
| Rate for Payer: Cigna of CA PPO |
$619.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$752.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$354.17
|
| Rate for Payer: Galaxy Health WC |
$752.62
|
| Rate for Payer: Global Benefits Group Commercial |
$531.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$796.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$664.07
|
| Rate for Payer: IEHP medi-cal |
$309.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.09
|
| Rate for Payer: Multiplan Commercial |
$664.07
|
| Rate for Payer: Networks By Design Commercial |
$442.72
|
| Rate for Payer: Prime Health Services Commercial |
$752.62
|
| Rate for Payer: Riverside University Health MISP |
$354.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$442.72
|
| Rate for Payer: United Healthcare All Other HMO |
$442.72
|
| Rate for Payer: United Healthcare HMO Rider |
$442.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.62
|
| Rate for Payer: Vantage Medical Group Senior |
$752.62
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
1710033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 69452-151-20
|
| Hospital Charge Code |
1710033
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: IEHP medi-cal |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Riverside University Health MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
NDG9943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
NDG9943
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.41
|
| Rate for Payer: Global Benefits Group Commercial |
$1.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.24
|
| Rate for Payer: IEHP medi-cal |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: Riverside University Health MISP |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO |
$0.83
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
OP
|
$14.82
|
|
|
Service Code
|
NDC 0781-5405-01
|
| Hospital Charge Code |
1712008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.76
|
| Rate for Payer: BCBS Transplant Transplant |
$8.89
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$7.25
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Central Health Plan Commercial |
$11.86
|
| Rate for Payer: Cigna of CA HMO |
$10.37
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$12.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.12
|
| Rate for Payer: IEHP medi-cal |
$5.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: Networks By Design Commercial |
$9.63
|
| Rate for Payer: Prime Health Services Commercial |
$12.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.89
|
| Rate for Payer: Riverside University Health MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.41
|
| Rate for Payer: United Healthcare All Other HMO |
$7.41
|
| Rate for Payer: United Healthcare HMO Rider |
$7.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
IP
|
$14.82
|
|
|
Service Code
|
NDC 0781-5405-01
|
| Hospital Charge Code |
1712008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.91
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Central Health Plan Commercial |
$11.86
|
| Rate for Payer: Cigna of CA HMO |
$10.37
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$12.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: Networks By Design Commercial |
$9.63
|
| Rate for Payer: Prime Health Services Commercial |
$12.60
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
IP
|
$820.80
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
1755763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$738.72 |
| Rate for Payer: Blue Shield of California Commercial |
$615.60
|
| Rate for Payer: Blue Shield of California EPN |
$438.31
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Central Health Plan Commercial |
$656.64
|
| Rate for Payer: Cigna of CA HMO |
$574.56
|
| Rate for Payer: Cigna of CA PPO |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$328.32
|
| Rate for Payer: Galaxy Health WC |
$697.68
|
| Rate for Payer: Global Benefits Group Commercial |
$492.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$615.60
|
| Rate for Payer: Networks By Design Commercial |
$410.40
|
| Rate for Payer: Prime Health Services Commercial |
$697.68
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
OP
|
$820.80
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
1755763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$830.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$134.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$830.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$167.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$173.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.89
|
| Rate for Payer: BCBS Transplant Transplant |
$492.48
|
| Rate for Payer: Blue Shield of California Commercial |
$155.76
|
| Rate for Payer: Blue Shield of California EPN |
$141.60
|
| Rate for Payer: Caremore Medicare Advantage |
$134.02
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Central Health Plan Commercial |
$656.64
|
| Rate for Payer: Cigna of CA HMO |
$574.56
|
| Rate for Payer: Cigna of CA PPO |
$574.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$134.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.02
|
| Rate for Payer: Galaxy Health WC |
$697.68
|
| Rate for Payer: Global Benefits Group Commercial |
$492.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$615.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$219.79
|
| Rate for Payer: IEHP medi-cal |
$221.13
|
| Rate for Payer: IEHP Medicare Advantage |
$134.02
|
| Rate for Payer: Innovage PACE Commercial |
$201.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.58
|
| Rate for Payer: Multiplan Commercial |
$615.60
|
| Rate for Payer: Networks By Design Commercial |
$410.40
|
| Rate for Payer: Prime Health Services Commercial |
$697.68
|
| Rate for Payer: Prime Health Services Medicare |
$142.06
|
| Rate for Payer: Riverside University Health MISP |
$147.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.40
|
| Rate for Payer: United Healthcare All Other HMO |
$410.40
|
| Rate for Payer: United Healthcare HMO Rider |
$410.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.42
|
| Rate for Payer: Vantage Medical Group Senior |
$134.02
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$80.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$91.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: BCBS Transplant Transplant |
$84.29
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: BCBS Transplant Transplant |
$92.63
|
| Rate for Payer: BCBS Transplant Transplant |
$99.94
|
| Rate for Payer: BCBS Transplant Transplant |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.38
|
| Rate for Payer: Central Health Plan Commercial |
$133.25
|
| Rate for Payer: Central Health Plan Commercial |
$123.51
|
| Rate for Payer: Cigna of CA HMO |
$108.07
|
| Rate for Payer: Cigna of CA HMO |
$116.59
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$39.90
|
| Rate for Payer: Cigna of CA PPO |
$116.59
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$108.07
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$39.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$141.58
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$131.23
|
| Rate for Payer: Global Benefits Group Commercial |
$99.94
|
| Rate for Payer: Global Benefits Group Commercial |
$92.63
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$124.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$115.79
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$115.79
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$124.92
|
| Rate for Payer: Networks By Design Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$77.20
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$141.58
|
| Rate for Payer: Prime Health Services Commercial |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health MISP |
$66.62
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Riverside University Health MISP |
$56.19
|
| Rate for Payer: Riverside University Health MISP |
$61.76
|
| Rate for Payer: Riverside University Health MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.24
|
| Rate for Payer: United Healthcare All Other HMO |
$83.28
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$77.20
|
| Rate for Payer: United Healthcare All Other HMO |
$70.24
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70.24
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$83.28
|
| Rate for Payer: United Healthcare HMO Rider |
$77.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$141.58
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
IP
|
$140.48
|
|
|
Service Code
|
CPT J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$126.43 |
| Rate for Payer: Blue Shield of California Commercial |
$105.36
|
| Rate for Payer: Blue Shield of California Commercial |
$124.92
|
| Rate for Payer: Blue Shield of California Commercial |
$115.79
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$42.75
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$75.02
|
| Rate for Payer: Blue Shield of California EPN |
$82.44
|
| Rate for Payer: Blue Shield of California EPN |
$88.94
|
| Rate for Payer: Blue Shield of California EPN |
$30.44
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.38
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Central Health Plan Commercial |
$133.25
|
| Rate for Payer: Central Health Plan Commercial |
$123.51
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$108.07
|
| Rate for Payer: Cigna of CA HMO |
$116.59
|
| Rate for Payer: Cigna of CA HMO |
$39.90
|
| Rate for Payer: Cigna of CA PPO |
$116.59
|
| Rate for Payer: Cigna of CA PPO |
$39.90
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$108.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$131.23
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$141.58
|
| Rate for Payer: Global Benefits Group Commercial |
$99.94
|
| Rate for Payer: Global Benefits Group Commercial |
$92.63
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.88
|
| Rate for Payer: Multiplan Commercial |
$115.79
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$124.92
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$77.20
|
| Rate for Payer: Networks By Design Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$141.58
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
1755709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Blue Shield of California Commercial |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.36
|
| Rate for Payer: Blue Shield of California EPN |
$75.02
|
| Rate for Payer: Blue Shield of California EPN |
$51.26
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Central Health Plan Commercial |
$112.38
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.10
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
OP
|
$140.48
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
1755709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$126.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: BCBS Transplant Transplant |
$84.29
|
| Rate for Payer: BCBS Transplant Transplant |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California Commercial |
$77.26
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Central Health Plan Commercial |
$112.38
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.00
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: IEHP medi-cal |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Riverside University Health MISP |
$38.40
|
| Rate for Payer: Riverside University Health MISP |
$56.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO |
$70.24
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70.24
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
