|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$11,972.51
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$8,934.71 |
| Max. Negotiated Rate |
$11,972.51 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,934.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,274.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,972.51
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 6936730730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 1672929310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 1672929310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 6936730730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.67
|
| Rate for Payer: TriValley Medical Group Senior |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
OP
|
$320.69
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| 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 Non-Gatekeeper |
$198.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$144.31
|
| 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 |
$147.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| 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 |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Multiplan Commercial |
$240.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$128.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$128.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$79.58
|
| Rate for Payer: TriValley Medical Group Senior |
$128.28
|
| Rate for Payer: TriValley Medical Group Senior |
$128.28
|
| Rate for Payer: TriValley Medical Group Senior |
$79.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
IP
|
$320.70
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$240.53 |
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Adventist Health Commercial |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.13
|
| 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: EPIC Health Plan Commercial |
$107.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$148.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.05
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$80.17
|
| Rate for Payer: Multiplan Commercial |
$240.53
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.18
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$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 |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$79.58
|
| Rate for Payer: TriValley Medical Group Senior |
$79.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 20,000 UNIT/2 ML INJECTION SOLUTION [117367]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.13
|
| 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 |
$92.12
|
| Rate for Payer: Heritage Provider Network Senior |
$92.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.74
|
| Rate for Payer: Multiplan Commercial |
$149.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.88
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
OP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$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 |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.97
|
| Rate for Payer: Heritage Provider Network Senior |
$296.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$305.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$256.56
|
| Rate for Payer: TriValley Medical Group Senior |
$256.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$212.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION [14643]
|
Facility
|
IP
|
$641.40
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$481.05 |
| Rate for Payer: Adventist Health Commercial |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$413.06
|
| 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 |
$296.97
|
| Rate for Payer: Heritage Provider Network Senior |
$296.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.35
|
| Rate for Payer: Multiplan Commercial |
$481.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$212.37
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
IP
|
$39.79
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$29.84 |
| Rate for Payer: Adventist Health Commercial |
$7.96
|
| Rate for Payer: Adventist Health Commercial |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.62
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.51
|
| 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 |
$18.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.70
|
| Rate for Payer: Heritage Provider Network Senior |
$29.70
|
| Rate for Payer: Heritage Provider Network Senior |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.04
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.17
|
|
|
EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION [9939]
|
Facility
|
OP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| 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 |
$24.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$17.91
|
| 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: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| 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 |
$29.70
|
| Rate for Payer: Heritage Provider Network Senior |
$18.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| 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/Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$48.11
|
| Rate for Payer: Multiplan Commercial |
$29.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.66
|
| Rate for Payer: TriValley Medical Group Senior |
$15.92
|
| Rate for Payer: TriValley Medical Group Senior |
$25.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$72.17 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Commercial |
$11.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$26.86
|
| 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 |
$8.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| 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 |
$6.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.64
|
| Rate for Payer: Heritage Provider Network Senior |
$44.55
|
| Rate for Payer: Heritage Provider Network Senior |
$27.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.49
|
| Rate for Payer: TriValley Medical Group Senior |
$23.88
|
| Rate for Payer: TriValley Medical Group Senior |
$38.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION [9940]
|
Facility
|
IP
|
$59.69
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
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 |
$61.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.44
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$26.86
|
| 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 |
$32.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.55
|
| Rate for Payer: Heritage Provider Network Senior |
$44.55
|
| Rate for Payer: Heritage Provider Network Senior |
$27.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: Multiplan Commercial |
$44.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.76
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
|
OP
|
$1,282.80
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$962.10 |
| Rate for Payer: Adventist Health Commercial |
$256.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$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 |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$820.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$593.94
|
| Rate for Payer: Heritage Provider Network Senior |
$593.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$611.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$962.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$513.12
|
| Rate for Payer: TriValley Medical Group Senior |
$513.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$463.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION [24513]
|
Facility
|
IP
|
$1,282.80
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
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 |
$826.12
|
| 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 |
$593.94
|
| Rate for Payer: Heritage Provider Network Senior |
$593.94
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$463.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.74
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
IP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$96.21 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.61
|
| 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 |
$59.39
|
| Rate for Payer: Heritage Provider Network Senior |
$59.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.47
|
|
|
EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$96.21 |
| Rate for Payer: Adventist Health Commercial |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.91
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$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 |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.39
|
| Rate for Payer: Heritage Provider Network Senior |
$59.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$61.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$96.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.57
|
| Rate for Payer: Vantage Medical Group Senior |
$7.57
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
OP
|
$138.95
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$104.21 |
| Rate for Payer: Adventist Health Commercial |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.76
|
| 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 |
$62.53
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.33
|
| Rate for Payer: Heritage Provider Network Senior |
$64.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$104.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.58
|
| Rate for Payer: TriValley Medical Group Senior |
$55.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION [221922]
|
Facility
|
IP
|
$138.95
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$104.21 |
| Rate for Payer: Adventist Health Commercial |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.48
|
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.33
|
| Rate for Payer: Heritage Provider Network Senior |
$64.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.74
|
| Rate for Payer: Multiplan Commercial |
$104.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.01
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
IP
|
$277.90
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$208.43 |
| Rate for Payer: Adventist Health Commercial |
$55.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.97
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.67
|
| Rate for Payer: Heritage Provider Network Senior |
$128.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.47
|
| Rate for Payer: Multiplan Commercial |
$208.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.01
|
|
|
EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION [229807]
|
Facility
|
OP
|
$277.90
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$208.43 |
| Rate for Payer: Adventist Health Commercial |
$55.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.76
|
| 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 |
$125.06
|
| Rate for Payer: Cash Price |
$125.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.67
|
| Rate for Payer: Heritage Provider Network Senior |
$128.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$132.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$208.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.16
|
| Rate for Payer: TriValley Medical Group Senior |
$111.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
OP
|
$27.79
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Adventist Health Commercial |
$5.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.76
|
| 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 |
$12.51
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.87
|
| Rate for Payer: Heritage Provider Network Senior |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$20.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.77
|
| Rate for Payer: Vantage Medical Group Senior |
$8.77
|
|
|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION [221919]
|
Facility
|
IP
|
$27.79
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Adventist Health Commercial |
$5.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.90
|
| Rate for Payer: Cash Price |
$12.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.87
|
| Rate for Payer: Heritage Provider Network Senior |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$20.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.20
|
|
