|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 43547-546-10
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 43547-546-10
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
OP
|
$0.57
|
|
|
Service Code
|
NDC 0904-5502-61
|
| Hospital Charge Code |
1711457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Senior |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Senior |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
Endocervical curettage (not done as part of a dilation and curettage)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 57505
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,004.43
|
| Rate for Payer: Humana Medicare |
$1,004.43
|
| Rate for Payer: IEHP Medi-Cal |
$226.50
|
| Rate for Payer: IEHP Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.87
|
| Rate for Payer: TriValley Medical Group Senior |
$1,004.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
Endometrial ablation, thermal, without hysteroscopic guidance
|
Facility
OP
|
$11,807.68
|
|
|
Service Code
|
CPT 58353
|
| Min. Negotiated Rate |
$1,665.49 |
| Max. Negotiated Rate |
$11,807.68 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,836.03
|
| Rate for Payer: Dignity Health Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,214.57
|
| Rate for Payer: Humana Medicare |
$6,214.57
|
| Rate for Payer: IEHP Medi-Cal |
$1,665.49
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,807.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,333.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,830.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,830.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,836.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6,214.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
|
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 58100
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: IEHP Medi-Cal |
$64.02
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$273.87
|
| Rate for Payer: TriValley Medical Group Senior |
$248.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar
|
Facility
OP
|
$16,983.21
|
|
|
Service Code
|
CPT 62380
|
| Min. Negotiated Rate |
$4,547.00 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$8,938.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 51715
|
| Min. Negotiated Rate |
$254.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$254.97
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,355.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
Endoscopy, wrist, surgical, with release of transverse carpal ligament
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 29848
|
| Min. Negotiated Rate |
$390.87 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$390.87
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,008.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36473
|
| Min. Negotiated Rate |
$2,154.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$2,154.14
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 36475
|
| Min. Negotiated Rate |
$3,102.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$3,102.89
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
OP
|
$3,181.20
|
|
|
Service Code
|
NDC 51144-020-01
|
| Hospital Charge Code |
ERX226724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$575.80 |
| Max. Negotiated Rate |
$2,704.02 |
| Rate for Payer: Adventist Health Commercial |
$636.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,700.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,185.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,704.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,749.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,385.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,975.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.36
|
| Rate for Payer: Cash Price |
$1,431.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,463.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,704.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,704.02
|
| Rate for Payer: Dignity Health Senior |
$2,704.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,035.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,472.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,472.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,533.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.30
|
| Rate for Payer: Multiplan Commercial |
$2,385.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,159.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,062.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,704.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2,704.02
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
IP
|
$3,181.20
|
|
|
Service Code
|
NDC 51144-020-01
|
| Hospital Charge Code |
ERX226724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$575.80 |
| Max. Negotiated Rate |
$2,385.90 |
| Rate for Payer: Adventist Health Commercial |
$636.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,185.48
|
| Rate for Payer: Cash Price |
$1,431.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,463.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,717.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,153.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2,153.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.30
|
| Rate for Payer: Multiplan Commercial |
$2,385.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,159.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,062.84
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
IP
|
$4,771.80
|
|
|
Service Code
|
NDC 51144-030-01
|
| Hospital Charge Code |
ERX226725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$863.70 |
| Max. Negotiated Rate |
$3,578.85 |
| Rate for Payer: Adventist Health Commercial |
$954.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,278.23
|
| Rate for Payer: Cash Price |
$2,147.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,195.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,576.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,230.51
|
| Rate for Payer: Heritage Provider Network Senior |
$3,230.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,192.95
|
| Rate for Payer: Multiplan Commercial |
$3,578.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,739.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,594.26
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
OP
|
$4,771.80
|
|
|
Service Code
|
NDC 51144-030-01
|
| Hospital Charge Code |
ERX226725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$863.70 |
| Max. Negotiated Rate |
$4,056.03 |
| Rate for Payer: Adventist Health Commercial |
$954.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,550.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,278.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,056.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,624.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,578.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,963.29
|
| Rate for Payer: Blue Shield of California EPN |
$2,801.05
|
| Rate for Payer: Cash Price |
$2,147.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,195.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,056.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,056.03
|
| Rate for Payer: Dignity Health Senior |
$4,056.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,053.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,209.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,209.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,300.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,192.95
|
| Rate for Payer: Multiplan Commercial |
$3,578.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,739.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,594.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,056.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,056.03
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: Dignity Health Senior |
$9.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.68
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.67
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.54
|
| Rate for Payer: Heritage Provider Network Senior |
$8.54
|
| Rate for Payer: Heritage Provider Network Senior |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$9.46
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.22
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Senior |
$10.73
|
| Rate for Payer: Dignity Health Senior |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.84
|
| Rate for Payer: Heritage Provider Network Senior |
$12.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5.84
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$9.46
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$10.73
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
OP
|
$44.72
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$38.01 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: Dignity Health Senior |
$32.69
|
| Rate for Payer: Dignity Health Senior |
$22.95
|
| Rate for Payer: Dignity Health Senior |
$38.01
|
| Rate for Payer: Dignity Health Senior |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.81
|
| Rate for Payer: Heritage Provider Network Senior |
$20.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.56
|
| Rate for Payer: Heritage Provider Network Senior |
$17.81
|
| Rate for Payer: Heritage Provider Network Senior |
$12.50
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Multiplan Commercial |
$33.54
|
| Rate for Payer: Multiplan Commercial |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$26.83
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$30.40
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$38.01
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.72
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$20.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.28
|
| Rate for Payer: Heritage Provider Network Senior |
$30.28
|
| Rate for Payer: Heritage Provider Network Senior |
$18.28
|
| Rate for Payer: Heritage Provider Network Senior |
$26.04
|
| Rate for Payer: Heritage Provider Network Senior |
$24.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$26.83
|
| Rate for Payer: Multiplan Commercial |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$33.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.94
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
OP
|
$25.66
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1753497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: Dignity Health Senior |
$25.30
|
| Rate for Payer: Dignity Health Senior |
$21.81
|
| Rate for Payer: Dignity Health Senior |
$10.88
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$13.78
|
| Rate for Payer: Heritage Provider Network Senior |
$11.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5.93
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.88
|
|
|
ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION [105940]
|
Facility
IP
|
$12.80
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1753497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.63
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.15
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8.67
|
| Rate for Payer: Heritage Provider Network Senior |
$17.37
|
| Rate for Payer: Heritage Provider Network Senior |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.28
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
IP
|
$23.88
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.40
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.17
|
| Rate for Payer: Heritage Provider Network Senior |
$18.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$16.17
|
| Rate for Payer: Heritage Provider Network Senior |
$17.37
|
| Rate for Payer: Heritage Provider Network Senior |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Multiplan Commercial |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$17.91
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [105899]
|
Facility
OP
|
$29.77
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Adventist Health Commercial |
$5.13
|
| Rate for Payer: Adventist Health Commercial |
$4.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.85
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.81
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: Dignity Health Senior |
$22.77
|
| Rate for Payer: Dignity Health Senior |
$25.30
|
| Rate for Payer: Dignity Health Senior |
$21.81
|
| Rate for Payer: Dignity Health Senior |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.78
|
| Rate for Payer: Heritage Provider Network Senior |
$12.40
|
| Rate for Payer: Heritage Provider Network Senior |
$13.78
|
| Rate for Payer: Heritage Provider Network Senior |
$8.33
|
| Rate for Payer: Heritage Provider Network Senior |
$11.06
|
| Rate for Payer: Heritage Provider Network Senior |
$11.88
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: IEHP Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$20.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$21.81
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
|
