|
ENALAPRIL MALEATE 2.5 MG TABLET [9925]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 4354754510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
ENALAPRIL MALEATE 2.5 MG TABLET [9925]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 6467992302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.29
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
|
|
ENALAPRIL MALEATE 2.5 MG TABLET [9925]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 6467992302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
ENALAPRIL MALEATE 5 MG TABLET [9927]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 4354754610
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| 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 4354754610
|
| Hospital Charge Code |
901700029
|
|
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 |
$0.16
|
| 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 Foundation Hospitals 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
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 5167240381
|
| Hospital Charge Code |
901700029
|
|
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 |
$0.16
|
| 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 Foundation Hospitals 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
|
$0.25
|
|
|
Service Code
|
NDC 5167240381
|
| Hospital Charge Code |
901700029
|
|
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 Non-Gatekeeper |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$16,440.94
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$12,269.36 |
| Max. Negotiated Rate |
$16,440.94 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,269.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,269.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,109.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,440.94
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$25,978.20
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$19,386.72 |
| Max. Negotiated Rate |
$25,978.20 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,386.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,386.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,294.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,978.20
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,499.20
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$9,327.76 |
| Max. Negotiated Rate |
$12,499.20 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,327.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,327.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,726.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,499.20
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH REMOVAL OF CALCULI/DEBRIS FROM BILIARY/PANCREATIC DUCT(S)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 43264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,958.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,421.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan WC |
$7,702.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,454.66
|
| Rate for Payer: TriValley Medical Group Senior |
$5,454.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 43262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,958.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,421.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan WC |
$7,702.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,454.66
|
| Rate for Payer: TriValley Medical Group Senior |
$5,454.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$88,333.70
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$65,920.67 |
| Max. Negotiated Rate |
$88,333.70 |
| Rate for Payer: EPIC Health Plan Medicare |
$65,920.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,920.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75,808.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88,333.70
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$94,806.03
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$70,750.77 |
| Max. Negotiated Rate |
$94,806.03 |
| Rate for Payer: EPIC Health Plan Medicare |
$70,750.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70,750.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,363.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94,806.03
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$73,805.87
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$55,079.01 |
| Max. Negotiated Rate |
$73,805.87 |
| Rate for Payer: EPIC Health Plan Medicare |
$55,079.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,079.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63,340.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73,805.87
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
|
OP
|
$3,421.37
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$2,566.03 |
| Rate for Payer: Adventist Health Commercial |
$684.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,114.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$35.82
|
| Rate for Payer: Blue Shield of California EPN |
$35.82
|
| Rate for Payer: Cash Price |
$1,539.62
|
| Rate for Payer: Cash Price |
$1,539.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,573.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,189.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$36.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,584.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,584.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,631.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$619.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.12
|
| Rate for Payer: Multiplan Commercial |
$2,566.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,368.55
|
| Rate for Payer: TriValley Medical Group Senior |
$1,368.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,236.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,132.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Vantage Medical Group Senior |
$40.33
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION [226724]
|
Facility
|
IP
|
$3,421.37
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$619.27 |
| Max. Negotiated Rate |
$2,566.03 |
| Rate for Payer: Adventist Health Commercial |
$684.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,203.36
|
| Rate for Payer: Cash Price |
$1,539.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,573.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,847.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,584.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,584.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$619.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.34
|
| Rate for Payer: Multiplan Commercial |
$2,566.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,236.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,132.82
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
|
OP
|
$5,132.04
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$3,849.03 |
| Rate for Payer: Adventist Health Commercial |
$1,026.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,171.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$35.82
|
| Rate for Payer: Blue Shield of California EPN |
$35.82
|
| Rate for Payer: Cash Price |
$2,309.42
|
| Rate for Payer: Cash Price |
$2,309.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,360.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,284.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$36.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,376.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,376.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,447.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$928.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.12
|
| Rate for Payer: Multiplan Commercial |
$3,849.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,052.82
|
| Rate for Payer: TriValley Medical Group Senior |
$2,052.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,854.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,699.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.33
|
| Rate for Payer: Vantage Medical Group Senior |
$40.33
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION [226725]
|
Facility
|
IP
|
$5,132.04
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$928.90 |
| Max. Negotiated Rate |
$3,849.03 |
| Rate for Payer: Adventist Health Commercial |
$1,026.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,305.03
|
| Rate for Payer: Cash Price |
$2,309.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,360.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,771.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,376.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,376.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$928.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.01
|
| Rate for Payer: Multiplan Commercial |
$3,849.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,854.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,699.22
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
|
IP
|
$11.18
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$8.38 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| 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 |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.18
|
| 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 |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| 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 |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.70
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [105903]
|
Facility
|
OP
|
$11.18
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cash Price |
$8.10
|
| 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: Dignity Health Commercial/Exchange |
$9.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| 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: Kaiser Foundation Hospitals Commercial |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$8.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$4.47
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.50
|
| 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 |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.50
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
|
OP
|
$12.62
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| 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 |
$6.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5.84
|
| Rate for Payer: Heritage Provider Network Senior |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$9.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Senior |
$6.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10.73
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [105904]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
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: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.13
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5.84
|
| Rate for Payer: Heritage Provider Network Senior |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$9.46
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Senior |
$12.50
|
| Rate for Payer: Heritage Provider Network Senior |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$14.24
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [31921]
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.39
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.50
|
| Rate for Payer: Heritage Provider Network Senior |
$12.50
|
| Rate for Payer: Heritage Provider Network Senior |
$7.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.55
|
|
