|
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
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
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) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
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) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
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) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
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
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.13
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.13
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2.69
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.27
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.55
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.82
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
OP
|
$1,376.95
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.23 |
| Max. Negotiated Rate |
$1,586.68 |
| Rate for Payer: Adventist Health Commercial |
$275.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$850.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,586.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,163.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,057.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,087.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,087.48
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$633.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,163.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,163.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,057.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.53
|
| Rate for Payer: Heritage Provider Network Senior |
$637.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,057.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$656.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,216.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,417.44
|
| Rate for Payer: Multiplan Commercial |
$1,032.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$550.78
|
| Rate for Payer: TriValley Medical Group Senior |
$550.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$497.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$455.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,163.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1,163.57
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
IP
|
$1,376.95
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.23 |
| Max. Negotiated Rate |
$1,032.71 |
| Rate for Payer: Adventist Health Commercial |
$275.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$886.76
|
| Rate for Payer: Cash Price |
$619.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$633.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.53
|
| Rate for Payer: Heritage Provider Network Senior |
$637.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.24
|
| Rate for Payer: Multiplan Commercial |
$1,032.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$497.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$455.91
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) 120 MG SOLUTION FOR INJECTION [222871]
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,020.10
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$728.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.39
|
| Rate for Payer: Heritage Provider Network Senior |
$733.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$572.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$524.46
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) 120 MG SOLUTION FOR INJECTION [222871]
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$2,957.51 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$871.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,957.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,346.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.40
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$728.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,346.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,346.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,013.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.39
|
| Rate for Payer: Heritage Provider Network Senior |
$733.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$755.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,108.80
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$572.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$524.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,346.40
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$106,314.96
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$79,339.52 |
| Max. Negotiated Rate |
$106,314.96 |
| Rate for Payer: EPIC Health Plan Medicare |
$79,339.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79,339.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,240.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106,314.96
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$65,550.78
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$48,918.49 |
| Max. Negotiated Rate |
$65,550.78 |
| Rate for Payer: EPIC Health Plan Medicare |
$48,918.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48,918.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,256.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65,550.78
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089321
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089321
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.76
|
| Rate for Payer: TriValley Medical Group Senior |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089421
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.76
|
| Rate for Payer: TriValley Medical Group Senior |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.76
|
| Rate for Payer: TriValley Medical Group Senior |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
OP
|
$6.91
|
|
|
Service Code
|
NDC 0003089470
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.87 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.84
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.76
|
| Rate for Payer: TriValley Medical Group Senior |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.87
|
| Rate for Payer: Vantage Medical Group Senior |
$5.87
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$6.91
|
|
|
Service Code
|
NDC 0003089470
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Adventist Health Commercial |
$1.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
|
