|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408078225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Senior |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (ADVATE) [408078225]
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408078225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ER408378225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| 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 |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Senior |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| 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 |
$0.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 2,000(+/-)UNIT IV SOLUTION (KOGENATE FS) [408378225]
|
Facility
|
IP
|
$2.42
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ER408378225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| 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 |
$1.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Senior |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 250 (+/-)UNIT IV SOLUTION (ADVATE) [408076365]
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408099576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH(ALB-FREE) 3,000(+/-) UNIT IV SOLUTION (ADVATE) [408099576]
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408099576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Senior |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
|
|
ANTIHEMOPHILIC FVIII,FULL LENGTH (ALB-FREE) 500 (+/-) UNIT IV SOLUTION (ADVATE) [408076366]
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
CPT J7192
|
| Hospital Charge Code |
ERX408076366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.66
|
| Rate for Payer: Dignity Health Senior |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.66
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 350 UNIT-650 UNIT INTRAVENOUS SOLN [225932]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
CPT J7198
|
| Hospital Charge Code |
ERX225932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.49
|
| Rate for Payer: Dignity Health Senior |
$2.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Humana Medicare |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 350 UNIT-650 UNIT INTRAVENOUS SOLN [225932]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
CPT J7198
|
| Hospital Charge Code |
ERX225932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
NDC 64193-424-02
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.10
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.02
|
|
|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN [225933]
|
Facility
|
OP
|
$3.05
|
|
|
Service Code
|
NDC 64193-424-02
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.59
|
| Rate for Payer: Dignity Health Senior |
$2.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.59
|
| Rate for Payer: Vantage Medical Group Senior |
$2.59
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
OP
|
$3.05
|
|
|
Service Code
|
CPT J7198
|
| Hospital Charge Code |
ERX117944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.49
|
| Rate for Payer: Dignity Health Senior |
$2.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1.41
|
| Rate for Payer: Humana Medicare |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.22
|
| Rate for Payer: TriValley Medical Group Senior |
$1.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.49
|
| Rate for Payer: Vantage Medical Group Senior |
$2.27
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN [117944]
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
CPT J7198
|
| Hospital Charge Code |
ERX117944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.10
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.02
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
CPT J7197
|
| Hospital Charge Code |
1720745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.46
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.68
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION [9116]
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
CPT J7197
|
| Hospital Charge Code |
1720745
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Adventist Health Commercial |
$1.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.26
|
| Rate for Payer: Dignity Health Senior |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.33
|
| Rate for Payer: Humana Medicare |
$3.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$3.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.26
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
OP
|
$1,224.89
|
|
|
Service Code
|
CPT J7511
|
| Hospital Charge Code |
1759922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.71 |
| Max. Negotiated Rate |
$2,282.28 |
| Rate for Payer: Adventist Health Commercial |
$244.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,282.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,161.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,021.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,021.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.42
|
| Rate for Payer: Blue Shield of California Commercial |
$991.58
|
| Rate for Payer: Blue Shield of California EPN |
$991.58
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$563.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,393.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,021.93
|
| Rate for Payer: Dignity Health Senior |
$1,021.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$929.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$567.12
|
| Rate for Payer: Heritage Provider Network Senior |
$567.12
|
| Rate for Payer: Humana Medicare |
$929.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$929.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,765.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,170.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,170.57
|
| Rate for Payer: Multiplan Commercial |
$918.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$489.96
|
| Rate for Payer: TriValley Medical Group Senior |
$489.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$446.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$409.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,393.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,021.93
|
| Rate for Payer: Vantage Medical Group Senior |
$929.03
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION [24585]
|
Facility
|
IP
|
$1,224.89
|
|
|
Service Code
|
CPT J7511
|
| Hospital Charge Code |
1759922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.71 |
| Max. Negotiated Rate |
$918.67 |
| Rate for Payer: Adventist Health Commercial |
$244.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$841.50
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$563.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$661.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$829.25
|
| Rate for Payer: Heritage Provider Network Senior |
$829.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.22
|
| Rate for Payer: Multiplan Commercial |
$918.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$446.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$409.24
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION [222871]
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT J0841
|
| Hospital Charge Code |
ERX222871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$2,607.29 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,240.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,140.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,003.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,607.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,244.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.40
|
| 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 |
$1,368.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,003.28
|
| Rate for Payer: Dignity Health Senior |
$1,003.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,013.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$912.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.39
|
| Rate for Payer: Heritage Provider Network Senior |
$733.39
|
| Rate for Payer: Humana Medicare |
$912.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,429.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$912.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,732.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,076.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,149.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,149.22
|
| 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 |
$577.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$529.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,368.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,003.28
|
| Rate for Payer: Vantage Medical Group Senior |
$912.08
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION [222871]
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT J0841
|
| Hospital Charge Code |
ERX222871
|
|
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 |
$1,088.21
|
| 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 |
$1,072.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,072.37
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$577.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$529.21
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
NDC 0003-0893-21
|
| Hospital Charge Code |
ERX199666
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.54
|
| Rate for Payer: Dignity Health Senior |
$9.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.49
|
| Rate for Payer: TriValley Medical Group Senior |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.54
|
|
|
APIXABAN 2.5 MG TABLET [199666]
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
NDC 0003-0893-21
|
| Hospital Charge Code |
ERX199666
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.71
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
APIXABAN 5 MG TABLET [199782]
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
NDC 0003-0894-31
|
| Hospital Charge Code |
ERX199782
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.71
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
