|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
|
|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
|
|
EPINEPHRINE IV INFUSION IN NS (LL) [40820174]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 9940-8201-72
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Senior |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
EPINEPHRINE IV INFUSION IN NS (LL) [40820174]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 9940-8201-72
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
|
OP
|
$2.31
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Senior |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Senior |
$0.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
|
IP
|
$2.31
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.76
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 69367-307-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 69367-307-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
OP
|
$320.70
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$240.53 |
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$176.39
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$176.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Multiplan Commercial |
$240.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$128.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$79.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$128.28
|
| Rate for Payer: TriValley Medical Group Senior |
$79.58
|
| Rate for Payer: TriValley Medical Group Senior |
$128.28
|
| Rate for Payer: TriValley Medical Group Senior |
$128.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
IP
|
$320.69
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.04 |
| Max. Negotiated Rate |
$240.52 |
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Cash Price |
$176.38
|
| Rate for Payer: Cash Price |
$176.39
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: Multiplan Commercial |
$240.53
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$79.58
|
| Rate for Payer: TriValley Medical Group Senior |
$79.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.95
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.44
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.97
|
| Rate for Payer: Heritage Provider Network Senior |
$296.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$305.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$256.56
|
| Rate for Payer: TriValley Medical Group Senior |
$256.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$212.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Cash Price |
$352.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.97
|
| Rate for Payer: Heritage Provider Network Senior |
$296.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$212.37
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
IP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Cash Price |
$35.28
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.70
|
| Rate for Payer: Heritage Provider Network Senior |
$29.70
|
| Rate for Payer: Heritage Provider Network Senior |
$18.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.95
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.17
|
|
