|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
OP
|
$320.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$240.52 |
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
NDG9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.31
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.70
|
| Rate for Payer: Heritage Provider Network Senior |
$217.11
|
| Rate for Payer: Heritage Provider Network Senior |
$134.70
|
| Rate for Payer: Heritage Provider Network Senior |
$217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.18
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.14
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
OP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
IP
|
$198.96
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.69
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.70
|
| Rate for Payer: Heritage Provider Network Senior |
$134.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.47
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
IP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.64
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$434.23
|
| Rate for Payer: Heritage Provider Network Senior |
$434.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$233.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.29
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
OP
|
$641.40
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cash Price |
$288.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.97
|
| Rate for Payer: Heritage Provider Network Senior |
$296.97
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$233.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
OP
|
$64.15
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$48.11 |
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.42
|
| Rate for Payer: Heritage Provider Network Senior |
$18.42
|
| Rate for Payer: Heritage Provider Network Senior |
$29.70
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| 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: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
IP
|
$64.15
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720614
|
|
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: Aetna of CA Non-Gatekeeper |
$27.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.07
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| 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 |
$21.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.43
|
| Rate for Payer: Heritage Provider Network Senior |
$43.43
|
| Rate for Payer: Heritage Provider Network Senior |
$26.94
|
| 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 |
$48.11
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.29
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
OP
|
$96.22
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$72.16 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| 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: Humana Medicare |
$8.89
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| 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 |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
IP
|
$59.69
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.80 |
| 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 Non-Gatekeeper |
$41.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.10
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.26
|
| 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 |
$40.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.14
|
| Rate for Payer: Heritage Provider Network Senior |
$40.41
|
| Rate for Payer: Heritage Provider Network Senior |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.06
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$72.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.94
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
OP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$256.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$590.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$820.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$593.94
|
| Rate for Payer: Heritage Provider Network Senior |
$593.94
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$962.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$467.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$428.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
IP
|
$1,282.80
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1756547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.19 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$256.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.28
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$590.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$868.46
|
| Rate for Payer: Heritage Provider Network Senior |
$868.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.70
|
| Rate for Payer: Multiplan Commercial |
$962.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$467.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$428.58
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
OP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$96.21 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.92
|
| Rate for Payer: Blue Shield of California EPN |
$16.92
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cash Price |
$57.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.77
|
| Rate for Payer: Dignity Health Senior |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.39
|
| Rate for Payer: Heritage Provider Network Senior |
$59.39
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: IEHP Medi-Cal |
$20.83
|
| Rate for Payer: IEHP Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
IP
|
$128.28
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
1720619
|
|
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: Aetna of CA Non-Gatekeeper |
$88.13
|
| Rate for Payer: Cash Price |
$57.73
|
| 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 |
$86.85
|
| Rate for Payer: Heritage Provider Network Senior |
$86.85
|
| 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 |
$46.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.86
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
OP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$99.27 |
| Rate for Payer: Adventist Health Commercial |
$26.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.59
|
| 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 |
$59.56
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: Dignity Health Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$19.16
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$99.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
IP
|
$132.36
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221922
|
|
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: Aetna of CA Non-Gatekeeper |
$90.93
|
| Rate for Payer: Cash Price |
$59.56
|
| 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 |
$89.61
|
| Rate for Payer: Heritage Provider Network Senior |
$89.61
|
| 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 |
$48.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.22
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
OP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$198.54 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.59
|
| 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 |
$119.12
|
| Rate for Payer: Cash Price |
$119.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: Dignity Health Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.57
|
| Rate for Payer: Heritage Provider Network Senior |
$122.57
|
| Rate for Payer: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$19.16
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$198.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$96.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$88.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
IP
|
$264.72
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG229807
|
|
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: Aetna of CA Non-Gatekeeper |
$181.86
|
| Rate for Payer: Cash Price |
$119.12
|
| 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 |
$179.22
|
| Rate for Payer: Heritage Provider Network Senior |
$179.22
|
| 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 |
$96.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$88.44
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
OP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$23.59 |
| Rate for Payer: Adventist Health Commercial |
$5.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.59
|
| 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 |
$11.91
|
| Rate for Payer: Cash Price |
$11.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: Dignity Health Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.26
|
| Rate for Payer: Heritage Provider Network Senior |
$12.26
|
| Rate for Payer: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$19.16
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$19.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
IP
|
$26.47
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221919
|
|
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: Aetna of CA Non-Gatekeeper |
$18.18
|
| Rate for Payer: Cash Price |
$11.91
|
| 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 |
$17.92
|
| Rate for Payer: Heritage Provider Network Senior |
$17.92
|
| 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 |
$9.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.84
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
OP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
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: Aetna of CA Gatekeeper |
$19.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.59
|
| 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 |
$17.87
|
| Rate for Payer: Cash Price |
$17.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: Dignity Health Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.39
|
| Rate for Payer: Heritage Provider Network Senior |
$18.39
|
| Rate for Payer: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$19.16
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION [221920]
|
Facility
IP
|
$39.71
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221920
|
|
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: Aetna of CA Non-Gatekeeper |
$27.28
|
| Rate for Payer: Cash Price |
$17.87
|
| 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 |
$26.88
|
| Rate for Payer: Heritage Provider Network Senior |
$26.88
|
| 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 |
$14.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.27
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
OP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$397.08 |
| Rate for Payer: Adventist Health Commercial |
$105.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.59
|
| 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 |
$238.25
|
| Rate for Payer: Cash Price |
$238.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.61
|
| Rate for Payer: Dignity Health Senior |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.13
|
| Rate for Payer: Heritage Provider Network Senior |
$245.13
|
| Rate for Payer: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$19.16
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$397.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$193.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$176.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION [221923]
|
Facility
IP
|
$529.44
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221923
|
|
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: Aetna of CA Non-Gatekeeper |
$363.73
|
| Rate for Payer: Cash Price |
$238.25
|
| 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 |
$358.43
|
| Rate for Payer: Heritage Provider Network Senior |
$358.43
|
| 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 |
$193.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$176.89
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION [221921]
|
Facility
IP
|
$52.94
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
NDG221921
|
|
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: Aetna of CA Non-Gatekeeper |
$36.37
|
| Rate for Payer: Cash Price |
$23.82
|
| 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 |
$35.84
|
| Rate for Payer: Heritage Provider Network Senior |
$35.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
|
