|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
IP
|
$254.51
|
|
|
Service Code
|
NDC 50242-091-30
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$216.33 |
| Rate for Payer: Blue Shield of California Commercial |
$181.21
|
| Rate for Payer: Blue Shield of California EPN |
$130.31
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.08
|
| Rate for Payer: Multiplan Commercial |
$203.61
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.10
|
| Rate for Payer: United Healthcare All Other HMO |
$93.86
|
| Rate for Payer: United Healthcare HMO Rider |
$91.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.99
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
OP
|
$254.51
|
|
|
Service Code
|
NDC 50242-094-90
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$216.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.64
|
| Rate for Payer: Blue Distinction Transplant |
$152.71
|
| Rate for Payer: Blue Shield of California Commercial |
$187.57
|
| Rate for Payer: Blue Shield of California EPN |
$148.63
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.33
|
| Rate for Payer: Dignity Health Media |
$216.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$190.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.08
|
| Rate for Payer: Multiplan Commercial |
$203.61
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.26
|
| Rate for Payer: United Healthcare All Other HMO |
$127.26
|
| Rate for Payer: United Healthcare HMO Rider |
$127.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.33
|
| Rate for Payer: Vantage Medical Group Senior |
$216.33
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
IP
|
$254.51
|
|
|
Service Code
|
NDC 50242-094-90
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$216.33 |
| Rate for Payer: Blue Shield of California Commercial |
$181.21
|
| Rate for Payer: Blue Shield of California EPN |
$130.31
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.08
|
| Rate for Payer: Multiplan Commercial |
$203.61
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.10
|
| Rate for Payer: United Healthcare All Other HMO |
$93.86
|
| Rate for Payer: United Healthcare HMO Rider |
$91.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.99
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
|
OP
|
$22,838.34
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,481.20 |
| Max. Negotiated Rate |
$19,412.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,979.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,412.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,561.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,561.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,607.08
|
| Rate for Payer: Blue Distinction Transplant |
$13,703.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16,831.86
|
| Rate for Payer: Blue Shield of California EPN |
$13,337.59
|
| Rate for Payer: Cash Price |
$10,277.25
|
| Rate for Payer: Cigna of CA HMO |
$15,986.84
|
| Rate for Payer: Cigna of CA PPO |
$15,986.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,412.59
|
| Rate for Payer: Dignity Health Media |
$19,412.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,412.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,135.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,135.34
|
| Rate for Payer: Galaxy Health WC |
$19,412.59
|
| Rate for Payer: Global Benefits Group Commercial |
$13,703.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,128.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,233.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,701.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,481.20
|
| Rate for Payer: Multiplan Commercial |
$18,270.67
|
| Rate for Payer: Networks By Design Commercial |
$11,419.17
|
| Rate for Payer: Prime Health Services Commercial |
$19,412.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,703.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,703.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,419.17
|
| Rate for Payer: United Healthcare All Other HMO |
$11,419.17
|
| Rate for Payer: United Healthcare HMO Rider |
$11,419.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,419.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,412.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,412.59
|
| Rate for Payer: Vantage Medical Group Senior |
$19,412.59
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
|
IP
|
$22,838.34
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,481.20 |
| Max. Negotiated Rate |
$19,412.59 |
| Rate for Payer: Blue Shield of California Commercial |
$16,260.90
|
| Rate for Payer: Blue Shield of California EPN |
$11,693.23
|
| Rate for Payer: Cash Price |
$10,277.25
|
| Rate for Payer: Cigna of CA HMO |
$15,986.84
|
| Rate for Payer: Cigna of CA PPO |
$15,986.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,135.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,135.34
|
| Rate for Payer: Galaxy Health WC |
$19,412.59
|
| Rate for Payer: Global Benefits Group Commercial |
$13,703.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,233.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,701.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,481.20
|
| Rate for Payer: Multiplan Commercial |
$18,270.67
|
| Rate for Payer: Networks By Design Commercial |
$11,419.17
|
| Rate for Payer: Prime Health Services Commercial |
$19,412.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,623.76
|
| Rate for Payer: United Healthcare All Other HMO |
$8,422.78
|
| Rate for Payer: United Healthcare HMO Rider |
$8,240.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,536.65
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION (MUST DILUTE) [238113]
|
Facility
|
OP
|
$1,903.20
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$456.77 |
| Max. Negotiated Rate |
$1,617.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,617.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,046.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,046.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,133.93
|
| Rate for Payer: Blue Distinction Transplant |
$1,141.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,111.47
|
| Rate for Payer: Cash Price |
$856.44
|
| Rate for Payer: Cigna of CA HMO |
$1,332.24
|
| Rate for Payer: Cigna of CA PPO |
$1,332.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,617.72
|
| Rate for Payer: Dignity Health Media |
$1,617.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,617.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$761.28
|
| Rate for Payer: Galaxy Health WC |
$1,617.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,141.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,427.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.77
|
| Rate for Payer: Multiplan Commercial |
$1,522.56
|
| Rate for Payer: Networks By Design Commercial |
$951.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,617.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,141.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,141.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.60
|
| Rate for Payer: United Healthcare All Other HMO |
$951.60
|
| Rate for Payer: United Healthcare HMO Rider |
$951.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,617.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,617.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1,617.72
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION (MUST DILUTE) [238113]
|
Facility
|
IP
|
$1,903.20
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$456.77 |
| Max. Negotiated Rate |
$1,617.72 |
| Rate for Payer: Blue Shield of California Commercial |
$1,355.08
|
| Rate for Payer: Blue Shield of California EPN |
$974.44
|
| Rate for Payer: Cash Price |
$856.44
|
| Rate for Payer: Cigna of CA HMO |
$1,332.24
|
| Rate for Payer: Cigna of CA PPO |
$1,332.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$761.28
|
| Rate for Payer: Galaxy Health WC |
$1,617.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,141.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.77
|
| Rate for Payer: Multiplan Commercial |
$1,522.56
|
| Rate for Payer: Networks By Design Commercial |
$951.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,617.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.65
|
| Rate for Payer: United Healthcare All Other HMO |
$701.90
|
| Rate for Payer: United Healthcare HMO Rider |
$686.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$628.06
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 70092-1478-44
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 70004-604-09
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 70004-604-09
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 70092-1478-44
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Blue Distinction Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Media |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-1
|
| Hospital Charge Code |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Blue Distinction Transplant |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$2.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Media |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-3
|
| Hospital Charge Code |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Blue Distinction Transplant |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$2.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Media |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-3
|
| Hospital Charge Code |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-1
|
| Hospital Charge Code |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.37
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$34.85
|
|
|
Service Code
|
NDC 70121-1637-1
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$29.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.76
|
| Rate for Payer: Blue Distinction Transplant |
$20.91
|
| Rate for Payer: Blue Shield of California Commercial |
$25.68
|
| Rate for Payer: Blue Shield of California EPN |
$20.35
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cigna of CA HMO |
$22.30
|
| Rate for Payer: Cigna of CA PPO |
$25.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.62
|
| Rate for Payer: Dignity Health Media |
$29.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.94
|
| Rate for Payer: Galaxy Health WC |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$27.88
|
| Rate for Payer: Networks By Design Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Commercial |
$29.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.42
|
| Rate for Payer: United Healthcare All Other HMO |
$17.42
|
| Rate for Payer: United Healthcare HMO Rider |
$17.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.62
|
| Rate for Payer: Vantage Medical Group Senior |
$29.62
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.29
|
| Rate for Payer: Blue Distinction Transplant |
$20.43
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.94
|
| Rate for Payer: Dignity Health Media |
$28.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.24
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO |
$17.02
|
| Rate for Payer: United Healthcare HMO Rider |
$17.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.94
|
| Rate for Payer: Vantage Medical Group Senior |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: Blue Shield of California Commercial |
$24.24
|
| Rate for Payer: Blue Shield of California EPN |
$17.43
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.24
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$13.37
|
|
|
Service Code
|
NDC 70756-611-82
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.85
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$10.70
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$14.96
|
|
|
Service Code
|
NDC 70700-249-22
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.91
|
| Rate for Payer: Blue Distinction Transplant |
$8.98
|
| Rate for Payer: Blue Shield of California Commercial |
$11.03
|
| Rate for Payer: Blue Shield of California EPN |
$8.74
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Cigna of CA HMO |
$9.57
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.72
|
| Rate for Payer: Dignity Health Media |
$12.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.98
|
| Rate for Payer: Galaxy Health WC |
$12.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Multiplan Commercial |
$11.97
|
| Rate for Payer: Networks By Design Commercial |
$9.72
|
| Rate for Payer: Prime Health Services Commercial |
$12.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO |
$7.48
|
| Rate for Payer: United Healthcare HMO Rider |
$7.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.72
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$48.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.81
|
| Rate for Payer: Blue Distinction Transplant |
$34.05
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Blue Shield of California EPN |
$33.14
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cigna of CA HMO |
$36.32
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: Dignity Health Media |
$48.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.62
|
| Rate for Payer: Multiplan Commercial |
$45.40
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.38
|
| Rate for Payer: United Healthcare All Other HMO |
$28.38
|
| Rate for Payer: United Healthcare HMO Rider |
$28.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.24
|
| Rate for Payer: Vantage Medical Group Senior |
$48.24
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$14.96
|
|
|
Service Code
|
NDC 70700-249-22
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Blue Shield of California Commercial |
$10.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.98
|
| Rate for Payer: Galaxy Health WC |
$12.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Multiplan Commercial |
$11.97
|
| Rate for Payer: Networks By Design Commercial |
$9.72
|
| Rate for Payer: Prime Health Services Commercial |
$12.72
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$34.85
|
|
|
Service Code
|
NDC 70121-1637-1
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$29.62 |
| Rate for Payer: Blue Shield of California Commercial |
$24.81
|
| Rate for Payer: Blue Shield of California EPN |
$17.84
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.94
|
| Rate for Payer: Galaxy Health WC |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$27.88
|
| Rate for Payer: Networks By Design Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Commercial |
$29.62
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.29
|
| Rate for Payer: Blue Distinction Transplant |
$20.43
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.94
|
| Rate for Payer: Dignity Health Media |
$28.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.24
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO |
$17.02
|
| Rate for Payer: United Healthcare HMO Rider |
$17.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.94
|
| Rate for Payer: Vantage Medical Group Senior |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$13.37
|
|
|
Service Code
|
NDC 70756-611-25
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.97
|
| Rate for Payer: Blue Distinction Transplant |
$8.02
|
| Rate for Payer: Blue Shield of California Commercial |
$9.85
|
| Rate for Payer: Blue Shield of California EPN |
$7.81
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$9.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.36
|
| Rate for Payer: Dignity Health Media |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$10.70
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.68
|
| Rate for Payer: United Healthcare HMO Rider |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.36
|
|
