|
EPINEPHRINE 2.5 MG/50 ML NS SYRINGE [4080666]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
EPINEPHRINE 2.5 MG/50 ML NS SYRINGE [4080666]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
|
|
EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE [220347]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Vantage Medical Group Senior |
$0.68
|
|
|
EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE [220347]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.68
|
| Rate for Payer: Global Benefits Group Commercial |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
|
|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.15
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.49
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
|
OP
|
$2.31
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$66.57 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
|
IP
|
$2.31
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.62
|
| Rate for Payer: Cigna of CA PPO |
$1.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$102,876.86
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$102,876.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,365.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,876.86
|
| Rate for Payer: EPIC Health Plan Senior |
$68,584.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,349.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,289.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,548.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$92,274.32
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$92,274.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,251.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,274.32
|
| Rate for Payer: EPIC Health Plan Senior |
$61,516.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,923.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,293.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,937.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 6936730730
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 1672929310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| 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 |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 |
$0.34 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| 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 |
$1.08
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Networks By Design Commercial |
$1.09
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare HMO Rider |
$0.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 1672929310
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION [9938]
|
Facility
|
IP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
901700041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$169.12 |
| 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: Blue Shield of California Commercial |
$246.61
|
| Rate for Payer: Blue Shield of California Commercial |
$100.87
|
| Rate for Payer: Blue Shield of California Commercial |
$153.00
|
| Rate for Payer: Blue Shield of California Commercial |
$246.62
|
| Rate for Payer: Blue Shield of California Commercial |
$162.59
|
| Rate for Payer: Blue Shield of California Commercial |
$162.59
|
| 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 |
$224.49
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$128.28
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$128.28
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.36
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare HMO Rider |
$114.61
|
| Rate for Payer: United Healthcare HMO Rider |
$114.62
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
|
|
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 |
$272.59 |
| 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 HMO/PPO |
$13.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| 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 |
$28.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.48
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Blue Shield of California Commercial |
$19.90
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.31
|
| Rate for Payer: Cash Price |
$144.32
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA HMO |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$224.49
|
| Rate for Payer: Cigna of CA PPO |
$224.48
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: EPIC Health Plan Senior |
$7.57
|
| Rate for Payer: Galaxy Health WC |
$272.60
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Galaxy Health WC |
$272.59
|
| Rate for Payer: Global Benefits Group Commercial |
$192.42
|
| Rate for Payer: Global Benefits Group Commercial |
$192.41
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Multiplan Commercial |
$256.55
|
| Rate for Payer: Multiplan Commercial |
$256.56
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Networks By Design Commercial |
$160.34
|
| Rate for Payer: Networks By Design Commercial |
$160.35
|
| Rate for Payer: Prime Health Services Commercial |
$272.59
|
| Rate for Payer: Prime Health Services Commercial |
$272.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.36
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare All Other HMO |
$117.15
|
| Rate for Payer: United Healthcare HMO Rider |
$114.61
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare HMO Rider |
$114.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.88
|
| 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 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 |
$39.79 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Adventist Health Commercial |
$39.79
|
| Rate for Payer: Blue Shield of California Commercial |
$100.87
|
| Rate for Payer: Blue Shield of California Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$89.53
|
| Rate for Payer: Cigna of CA HMO |
$139.27
|
| Rate for Payer: Cigna of CA PPO |
$139.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$139.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.58
|
| Rate for Payer: EPIC Health Plan Senior |
$79.58
|
| Rate for Payer: Galaxy Health WC |
$169.12
|
| Rate for Payer: Global Benefits Group Commercial |
$119.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$126.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$117.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$159.17
|
| Rate for Payer: Networks By Design Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Commercial |
$169.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.67
|
| Rate for Payer: United Healthcare All Other HMO |
$72.68
|
| Rate for Payer: United Healthcare HMO Rider |
$71.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.16
|
|
