|
ENTECAVIR 0.05 MG/ML ORAL SOLUTION [41149]
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 0003-1614-12
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$4.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.77
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$4.39
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.67
|
| Rate for Payer: Global Benefits Group Commercial |
$3.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$4.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: InnovAge PACE Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Vantage Medical Group Senior |
$0.27
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.94
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$1.12
|
| Rate for Payer: Cigna of CA PPO |
$1.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.44
|
| Rate for Payer: InnovAge PACE Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$1.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.36
|
| Rate for Payer: Riverside University Health System MISP |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.80
|
| Rate for Payer: United Healthcare All Other HMO |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
|
IP
|
$0.32
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.27
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
NDC 50242-091-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$252.54 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Blue Shield of California Commercial |
$216.90
|
| Rate for Payer: Blue Shield of California EPN |
$141.42
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Central Health Plan Commercial |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
NDC 50242-091-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$252.54 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.80
|
| Rate for Payer: Blue Shield of California Commercial |
$171.45
|
| Rate for Payer: Blue Shield of California EPN |
$111.96
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Central Health Plan Commercial |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.54
|
| Rate for Payer: InnovAge PACE Commercial |
$140.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.42
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
| Rate for Payer: Riverside University Health System MISP |
$112.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.30
|
| Rate for Payer: United Healthcare All Other HMO |
$140.30
|
| Rate for Payer: United Healthcare HMO Rider |
$140.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.51
|
| Rate for Payer: Vantage Medical Group Senior |
$238.51
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
NDC 50242-094-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$252.54 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.80
|
| Rate for Payer: Blue Shield of California Commercial |
$171.45
|
| Rate for Payer: Blue Shield of California EPN |
$111.96
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Central Health Plan Commercial |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.54
|
| Rate for Payer: InnovAge PACE Commercial |
$140.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.42
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
| Rate for Payer: Riverside University Health System MISP |
$112.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.30
|
| Rate for Payer: United Healthcare All Other HMO |
$140.30
|
| Rate for Payer: United Healthcare HMO Rider |
$140.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.51
|
| Rate for Payer: Vantage Medical Group Senior |
$238.51
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
NDC 50242-094-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.12 |
| Max. Negotiated Rate |
$252.54 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Blue Shield of California Commercial |
$216.90
|
| Rate for Payer: Blue Shield of California EPN |
$141.42
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Central Health Plan Commercial |
$224.48
|
| Rate for Payer: Cigna of CA HMO |
$196.42
|
| Rate for Payer: Cigna of CA PPO |
$196.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.24
|
| Rate for Payer: EPIC Health Plan Senior |
$112.24
|
| Rate for Payer: Galaxy Health WC |
$238.51
|
| Rate for Payer: Global Benefits Group Commercial |
$168.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
| Rate for Payer: Networks By Design Commercial |
$182.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.51
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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: Anthem Blue Cross of CA Exchange |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| 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: InnovAge PACE Commercial |
$1.48
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| 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 |
$1.48
|
| 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 0641-6236-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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 |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| 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 |
$1.92
|
| 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 |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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 |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| 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 |
$1.92
|
| 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 |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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: Anthem Blue Cross of CA Exchange |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| 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: InnovAge PACE Commercial |
$1.48
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| 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 |
$1.48
|
| 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 |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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 |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| 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 |
$1.92
|
| 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 0641-6236-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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 |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Permanente of CA Commercial/Self Funded |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| 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 |
$1.92
|
| 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 51754-4250-3
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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: Anthem Blue Cross of CA Exchange |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| 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: InnovAge PACE Commercial |
$1.48
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| 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 |
$1.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1.48
|
| Rate for Payer: United Healthcare HMO Rider |
$1.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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: Anthem Blue Cross of CA Exchange |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.18
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| 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 Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| 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: InnovAge PACE Commercial |
$1.48
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$1.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Networks By Design Commercial |
$1.92
|
| 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 |
$1.48
|
| 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
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.85
|
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$14.78
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$7.39
|
| Rate for Payer: Galaxy Health WC |
$15.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.63
|
| Rate for Payer: InnovAge PACE Commercial |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
| Rate for Payer: Networks By Design Commercial |
$12.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.71
|
| Rate for Payer: Riverside University Health System MISP |
$7.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.24
|
| Rate for Payer: United Healthcare All Other HMO |
$9.24
|
| Rate for Payer: United Healthcare HMO Rider |
$9.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.71
|
| Rate for Payer: Vantage Medical Group Senior |
$15.71
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California EPN |
$9.31
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$7.39
|
| Rate for Payer: Galaxy Health WC |
$15.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
| Rate for Payer: Networks By Design Commercial |
$12.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.71
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.85
|
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$14.78
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$7.39
|
| Rate for Payer: Galaxy Health WC |
$15.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.63
|
| Rate for Payer: InnovAge PACE Commercial |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
| Rate for Payer: Networks By Design Commercial |
$12.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.71
|
| Rate for Payer: Riverside University Health System MISP |
$7.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.24
|
| Rate for Payer: United Healthcare All Other HMO |
$9.24
|
| Rate for Payer: United Healthcare HMO Rider |
$9.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.71
|
| Rate for Payer: Vantage Medical Group Senior |
$15.71
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.63 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California EPN |
$9.31
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Central Health Plan Commercial |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.39
|
| Rate for Payer: EPIC Health Plan Senior |
$7.39
|
| Rate for Payer: Galaxy Health WC |
$15.71
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
| Rate for Payer: Networks By Design Commercial |
$12.01
|
| Rate for Payer: Prime Health Services Commercial |
$15.71
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Adventist Health Commercial |
$11.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.67
|
| Rate for Payer: Blue Shield of California EPN |
$22.64
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: Central Health Plan Commercial |
$45.40
|
| Rate for Payer: Cigna of CA HMO |
$36.32
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Senior |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.08
|
| Rate for Payer: InnovAge PACE Commercial |
$28.38
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$35.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.73
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
| Rate for Payer: Riverside University Health System MISP |
$22.70
|
| 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
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Adventist Health Commercial |
$11.35
|
| Rate for Payer: Blue Shield of California Commercial |
$43.87
|
| Rate for Payer: Blue Shield of California EPN |
$28.60
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: Central Health Plan Commercial |
$45.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Senior |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.08
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$35.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 42023-243-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.13
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
| 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 14789-250-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.13
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
| Rate for Payer: Networks By Design Commercial |
$2.26
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
|
