|
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: AlphaCare Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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 51754-4250-1
|
| 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 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
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: AlphaCare Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$8.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.97
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$12.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.91
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
$9.35
|
|
|
Service Code
|
NDC 70700-249-25
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.57
|
| Rate for Payer: BCBS Transplant Transplant |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$6.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Media |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.48
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$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: 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.97
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
|
|
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
|
$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: Blue Shield of California Commercial |
$40.41
|
| Rate for Payer: Blue Shield of California EPN |
$29.06
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| 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
|
|
|
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
|
$34.85
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.76
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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 0781-3269-95
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.29
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.29
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.81
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
$34.05
|
|
|
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: 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
IP
|
$9.35
|
|
|
Service Code
|
NDC 70700-249-25
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Blue Shield of California Commercial |
$6.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$7.48
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 14789-250-10
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Media |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
IP
|
$3.48
|
|
|
Service Code
|
NDC 42023-243-01
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$2.26
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
IP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-07
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.78
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$2.26
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
OP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-07
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.07
|
| Rate for Payer: BCBS Transplant Transplant |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cigna of CA HMO |
$2.23
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Media |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$2.26
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 14789-250-10
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Blue Shield of California Commercial |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.72
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
