|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [105902]
|
Facility
IP
|
$26.82
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
1721093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Blue Shield of California Commercial |
$19.10
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$13.73
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cigna of CA HMO |
$18.77
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$18.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$13.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-11
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: BCBS Transplant Transplant |
$2.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Media |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-21
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-11
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Blue Shield of California Commercial |
$3.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
|
|
ENTACAPONE 200 MG TABLET [26547]
|
Facility
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687-188-21
|
| Hospital Charge Code |
1711797
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: BCBS Transplant Transplant |
$2.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.20
|
| Rate for Payer: Dignity Health Media |
$4.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.98
|
| Rate for Payer: Galaxy Health WC |
$4.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.95
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Commercial |
$4.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2.47
|
| Rate for Payer: United Healthcare HMO Rider |
$2.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.20
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
IP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
1715226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
|
|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
OP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
1715226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.27
|
| Rate for Payer: BCBS Transplant Transplant |
$3.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.67
|
| Rate for Payer: Dignity Health Media |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.39
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Vantage Medical Group Senior |
$4.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
OP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: BCBS Transplant Transplant |
$0.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Media |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
IP
|
$3.14
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$1.61
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
OP
|
$2.56
|
|
|
Service Code
|
NDC 69097-426-02
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: BCBS Transplant Transplant |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: Dignity Health Media |
$2.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
IP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
OP
|
$3.14
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.87
|
| Rate for Payer: BCBS Transplant Transplant |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.83
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Media |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.51
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
IP
|
$2.56
|
|
|
Service Code
|
NDC 69097-426-02
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$166.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$139.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.64
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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 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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$139.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.64
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$19,412.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,561.09
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant 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 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$1,617.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,046.76
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant 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
|
|
|
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: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.14
|
| 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: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: BCBS Transplant Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.51
|
| 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 Transplant 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 (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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
$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
|
|
