|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| 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 |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Riverside University Health System MISP |
$1.18
|
| 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 |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| 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
|
$9.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.84
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION WRAP. [408233841]
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Blue Shield of California EPN |
$2.40
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$3.33
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$3.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Networks By Design Commercial |
$2.38
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION WRAP. [408233841]
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| 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 Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Cigna of CA HMO |
$3.33
|
| Rate for Payer: Cigna of CA HMO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$2.07
|
| Rate for Payer: Cigna of CA PPO |
$3.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$2.38
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$2.52
|
| Rate for Payer: Riverside University Health System MISP |
$1.90
|
| Rate for Payer: Riverside University Health System MISP |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| 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 Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.45
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Prime Health Services Commercial |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$144.36
|
| Rate for Payer: Blue Shield of California EPN |
$90.72
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$114.12
|
| Rate for Payer: Blue Shield of California EPN |
$71.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Riverside University Health System MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
|
|
EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$7.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO |
$5.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.47
|
| Rate for Payer: Global Benefits Group Commercial |
$0.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.28
|
| Rate for Payer: Prime Health Services Commercial |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$9.84
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$11.10 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Riverside University Health System MISP |
$3.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.59
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$8.99
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$195.06
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California Commercial |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California Commercial |
$782.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$491.55
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$438.88
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: Central Health Plan Commercial |
$7.19
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$780.24
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$682.71
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$682.71
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$390.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$829.00
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$585.18
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.06
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$487.65
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$829.00
|
| Rate for Payer: Prime Health Services Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Other HMO |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$356.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$348.57
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.41
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$9.84
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$8.99
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$195.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$592.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$829.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$536.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$731.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$618.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$389.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$438.88
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$438.88
|
| Rate for Payer: Central Health Plan Commercial |
$780.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.19
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$7.87
|
| Rate for Payer: Cigna of CA HMO |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$682.71
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$682.71
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$6.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$829.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$829.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$829.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$390.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.94
|
| Rate for Payer: Galaxy Health WC |
$829.00
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Galaxy Health WC |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$585.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$682.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$487.65
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Commercial |
$829.00
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| Rate for Payer: Riverside University Health System MISP |
$390.12
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Riverside University Health System MISP |
$3.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$585.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$356.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$3.28
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$348.57
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$829.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$829.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$829.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Blue Shield of California EPN |
$4.31
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$8.66
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$11.10 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$3.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.33
|
| Rate for Payer: Riverside University Health System MISP |
$1.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.33
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.29
|
| Rate for Payer: United Healthcare HMO Rider |
$3.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.98
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.57
|
| Rate for Payer: EPIC Health Plan Senior |
$1.57
|
| Rate for Payer: Galaxy Health WC |
$3.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
|
