|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
IP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$65.53 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.45
|
| Rate for Payer: Heritage Provider Network Senior |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
OP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: Dignity Health Senior |
$74.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.45
|
| Rate for Payer: Heritage Provider Network Senior |
$40.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.16
|
| Rate for Payer: Multiplan Commercial |
$65.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.95
|
| Rate for Payer: TriValley Medical Group Senior |
$34.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 3 G/100 ML IN NS [400006]
|
Facility
|
IP
|
$86.08
|
|
|
Service Code
|
NDC 9940-8203-96
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$64.56 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.28
|
| Rate for Payer: Heritage Provider Network Senior |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$64.56
|
|
|
AMPICILLIN-SULBACTAM 3 G/100 ML IN NS [400006]
|
Facility
|
OP
|
$86.08
|
|
|
Service Code
|
NDC 9940-8203-96
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$73.17 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.56
|
| Rate for Payer: Blue Shield of California Commercial |
$52.51
|
| Rate for Payer: Blue Shield of California EPN |
$42.01
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.17
|
| Rate for Payer: Dignity Health Senior |
$73.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.28
|
| Rate for Payer: Heritage Provider Network Senior |
$53.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.26
|
| Rate for Payer: Multiplan Commercial |
$64.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.17
|
| Rate for Payer: Vantage Medical Group Senior |
$73.17
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.11
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Senior |
$5.47
|
| Rate for Payer: Dignity Health Senior |
$14.85
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.99
|
| Rate for Payer: TriValley Medical Group Senior |
$6.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.57
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$377.35
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$283.01 |
| Rate for Payer: Adventist Health Commercial |
$75.47
|
| Rate for Payer: Cash Price |
$207.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.71
|
| Rate for Payer: Heritage Provider Network Senior |
$174.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.34
|
| Rate for Payer: Multiplan Commercial |
$283.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$136.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$124.94
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$377.35
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$320.75 |
| Rate for Payer: Adventist Health Commercial |
$75.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.01
|
| Rate for Payer: Blue Shield of California Commercial |
$230.18
|
| Rate for Payer: Blue Shield of California EPN |
$184.15
|
| Rate for Payer: Cash Price |
$207.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.75
|
| Rate for Payer: Dignity Health Senior |
$320.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.71
|
| Rate for Payer: Heritage Provider Network Senior |
$174.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.14
|
| Rate for Payer: Multiplan Commercial |
$283.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.94
|
| Rate for Payer: TriValley Medical Group Senior |
$150.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$136.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$124.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.75
|
| Rate for Payer: Vantage Medical Group Senior |
$320.75
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Senior |
$0.93
|
| Rate for Payer: Dignity Health Senior |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$171.80 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.06
|
| Rate for Payer: Heritage Provider Network Senior |
$106.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.27
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.85
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
OP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$122.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Senior |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.06
|
| Rate for Payer: Heritage Provider Network Senior |
$106.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$91.63
|
| Rate for Payer: TriValley Medical Group Senior |
$91.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.82
|
| Rate for Payer: Heritage Provider Network Senior |
$37.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.97
|
| Rate for Payer: Multiplan Commercial |
$41.90
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994-0810-55
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Adventist Health Commercial |
$11.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.90
|
| Rate for Payer: Blue Shield of California Commercial |
$34.08
|
| Rate for Payer: Blue Shield of California EPN |
$27.26
|
| Rate for Payer: Cash Price |
$30.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.49
|
| Rate for Payer: Dignity Health Senior |
$47.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.58
|
| Rate for Payer: Heritage Provider Network Senior |
$34.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.11
|
| Rate for Payer: Multiplan Commercial |
$41.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Vantage Medical Group Senior |
$47.49
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Senior |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.78
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Senior |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Senior |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.84
|
| Rate for Payer: TriValley Medical Group Senior |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000(VWF 1,000) UNIT/10 ML INTRAVENOUS SOLN [214027]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.70
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.64
|
| Rate for Payer: Dignity Health Senior |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1.64
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Senior |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS J7186
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.35
|
| Rate for Payer: Dignity Health Senior |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Senior |
$0.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.66
|
| Rate for Payer: TriValley Medical Group Senior |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1.35
|
|
