|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
OP
|
$55.87
|
|
|
Service Code
|
NDC 9994081055
|
| 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 Non-Gatekeeper |
$34.53
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$27.95
|
| 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 |
$25.14
|
| 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 Medicare Advantage |
$47.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.58
|
| Rate for Payer: Heritage Provider Network Senior |
$34.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]
|
Facility
|
IP
|
$55.87
|
|
|
Service Code
|
NDC 9994081055
|
| 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: Aetna of CA Non-Gatekeeper |
$35.98
|
| Rate for Payer: Cash Price |
$25.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.82
|
| Rate for Payer: Heritage Provider Network Senior |
$37.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.97
|
| Rate for Payer: Multiplan Commercial |
$41.90
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 1,500 (+/-) UNIT IV SOLUTION [76368]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.55
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [70406]
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$0.92
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 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 |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| 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 |
$0.94
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.33
|
| 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) Medicare Advantage |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.78
|
| 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 |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1.35
|
| Rate for Payer: Cash Price |
$0.94
|
| 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 Foundation Hospitals 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
|
IP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [70404]
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$0.92
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
HCPCS J7186
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.09
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 (200 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [88336]
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
HCPCS J7186
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.05
|
| 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 |
$2.83
|
| 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 |
$0.76
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Senior |
$0.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Senior |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
| 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 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
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: Aetna of CA Non-Gatekeeper |
$1.35
|
| Rate for Payer: Cash Price |
$0.94
|
| 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 Foundation Hospitals 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 500 (500 VWF) UNIT/5 ML INTRAVENOUS SOLUTION [214026]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J7183
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| 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 |
$0.94
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.33
|
| 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) Medicare Advantage |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.78
|
| 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 |
$1.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$0.92
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.06
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1.69
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT INTRAVENOUS SOLUTION [70405]
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.55
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 1,000(+/-) UNIT IV SOLUTION (ADVATE) [408076367]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.56
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE)1,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408376367]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.55
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.56
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| 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 |
$1.09
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$1.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.55
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.79
|
|
