|
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
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$72.17 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.55
|
| Rate for Payer: Heritage Provider Network Senior |
$44.55
|
| Rate for Payer: Heritage Provider Network Senior |
$27.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.76
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
OP
|
$59.69
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$44.77 |
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.10
|
| 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 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: 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: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cash Price |
$32.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.26
|
| 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 Senior |
$8.44
|
| Rate for Payer: Dignity Health Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.58
|
| 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 |
$27.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.55
|
| Rate for Payer: Heritage Provider Network Senior |
$27.64
|
| Rate for Payer: Heritage Provider Network Senior |
$44.55
|
| 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: Kaiser Permanente of CA Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| 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 |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| 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: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.88
|
| Rate for Payer: TriValley Medical Group Senior |
$23.88
|
| Rate for Payer: TriValley Medical Group Senior |
$38.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.86
|
| 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 Senior |
$8.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$96.21 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.39
|
| Rate for Payer: Heritage Provider Network Senior |
$59.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.47
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$96.21 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.13
|
| 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 |
$70.55
|
| Rate for Payer: Cash Price |
$70.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.01
|
| 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 |
$82.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.39
|
| Rate for Payer: Heritage Provider Network Senior |
$59.39
|
| 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 |
$61.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| 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 |
$96.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.47
|
| 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-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$99.27 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.09
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.82
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$99.27 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.94
|
| Rate for Payer: TriValley Medical Group Senior |
$52.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$264.72
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$198.54 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$141.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.57
|
| Rate for Payer: Heritage Provider Network Senior |
$122.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$105.89
|
| Rate for Payer: TriValley Medical Group Senior |
$105.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$264.72
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$198.54 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.57
|
| Rate for Payer: Heritage Provider Network Senior |
$122.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.18
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.65
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.59
|
| Rate for Payer: TriValley Medical Group Senior |
$10.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.76
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.39
|
| Rate for Payer: Heritage Provider Network Senior |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.15
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.39
|
| Rate for Payer: Heritage Provider Network Senior |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.88
|
| Rate for Payer: TriValley Medical Group Senior |
$15.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$397.08 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$282.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.13
|
| Rate for Payer: Heritage Provider Network Senior |
$245.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$252.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$211.78
|
| Rate for Payer: TriValley Medical Group Senior |
$211.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
|
IP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$397.08 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.13
|
| Rate for Payer: Heritage Provider Network Senior |
$245.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.36
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.30
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$39.70 |
| Rate for Payer: Adventist Health Commercial |
$10.59
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.53
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$39.70 |
| Rate for Payer: Adventist Health Commercial |
$10.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.18
|
| Rate for Payer: TriValley Medical Group Senior |
$21.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
IP
|
$53.40
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Adventist Health Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.72
|
| Rate for Payer: Heritage Provider Network Senior |
$24.72
|
| Rate for Payer: Heritage Provider Network Senior |
$30.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.35
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Multiplan Commercial |
$40.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.68
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION [153307]
|
Facility
|
OP
|
$66.31
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$56.36 |
| Rate for Payer: Adventist Health Commercial |
$13.26
|
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$19.07
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.36
|
| Rate for Payer: Dignity Health Senior |
$45.39
|
| Rate for Payer: Dignity Health Senior |
$56.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.72
|
| Rate for Payer: Heritage Provider Network Senior |
$24.72
|
| Rate for Payer: Heritage Provider Network Senior |
$30.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.42
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Multiplan Commercial |
$40.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.36
|
| Rate for Payer: TriValley Medical Group Senior |
$21.36
|
| Rate for Payer: TriValley Medical Group Senior |
$26.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.36
|
| Rate for Payer: Vantage Medical Group Senior |
$45.39
|
| Rate for Payer: Vantage Medical Group Senior |
$56.36
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.39
|
| Rate for Payer: Heritage Provider Network Senior |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.43
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION [15897]
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$19.07
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.07
|
| Rate for Payer: Dignity Health Senior |
$19.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.39
|
| Rate for Payer: Heritage Provider Network Senior |
$10.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.70
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.97
|
| Rate for Payer: TriValley Medical Group Senior |
$8.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Vantage Medical Group Senior |
$19.07
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$19.07
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.04
|
| Rate for Payer: Dignity Health Senior |
$46.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.08
|
| Rate for Payer: Heritage Provider Network Senior |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$40.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.67
|
| Rate for Payer: TriValley Medical Group Senior |
$21.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.04
|
| Rate for Payer: Vantage Medical Group Senior |
$46.04
|
|
|
EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION [15898]
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$40.63 |
| Rate for Payer: Adventist Health Commercial |
$10.83
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.08
|
| Rate for Payer: Heritage Provider Network Senior |
$25.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$40.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.94
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$27.52 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.52
|
| Rate for Payer: Blue Shield of California Commercial |
$10.84
|
| Rate for Payer: Blue Shield of California EPN |
$10.84
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION [23123]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
|
