|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$2.23
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.96
|
| 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: InnovAge PACE Commercial |
$1.74
|
| 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: Molina Healthcare of CA Medi-Cal |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.44
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
IP
|
$3.48
|
|
|
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
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-07
|
| 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: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$2.23
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.96
|
| 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: InnovAge PACE Commercial |
$1.74
|
| 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: Molina Healthcare of CA Medi-Cal |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.44
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
IP
|
$3.48
|
|
|
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
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.32
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: InnovAge PACE Commercial |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
| Rate for Payer: Riverside University Health System MISP |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1.40
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.83
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$1.32
|
| Rate for Payer: Cigna of CA HMO |
$1.16
|
| Rate for Payer: Cigna of CA PPO |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$0.83
|
| Rate for Payer: Prime Health Services Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
|
|
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 |
$139.14
|
| Rate for Payer: Blue Shield of California EPN |
$90.72
|
| Rate for Payer: Cash Price |
$99.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| 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 |
$0.84 |
| 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 |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$109.98
|
| Rate for Payer: Blue Shield of California EPN |
$71.82
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| 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: 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: InnovAge PACE Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| 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 |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| 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: 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: InnovAge PACE Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.50
|
| Rate for Payer: Molina Healthcare of CA 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 1.25 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 |
$11.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$8.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| 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 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 |
$2.75 |
| 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 |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| 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: 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: InnovAge PACE Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
| Rate for Payer: Molina Healthcare of CA 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 |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.30
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.34
|
| 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
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| 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 |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| 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: 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: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA 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
|
$17.95
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Adventist Health Commercial |
$3.59
|
| Rate for Payer: Adventist Health Commercial |
$195.06
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California Commercial |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$753.91
|
| Rate for Payer: Blue Shield of California Commercial |
$6.95
|
| Rate for Payer: Blue Shield of California EPN |
$9.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$491.55
|
| Rate for Payer: Cash Price |
$536.42
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Central Health Plan Commercial |
$780.24
|
| Rate for Payer: Central Health Plan Commercial |
$14.36
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$7.19
|
| Rate for Payer: Cigna of CA HMO |
$12.56
|
| 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 |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$12.56
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$682.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$390.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$15.26
|
| Rate for Payer: Galaxy Health WC |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$829.00
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.77
|
| Rate for Payer: Global Benefits Group Commercial |
$585.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$650.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$603.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| 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: Multiplan Commercial |
$731.48
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Networks By Design Commercial |
$487.65
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$8.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.26
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$829.00
|
| 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 |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.74
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$356.28
|
| Rate for Payer: United Healthcare All Other HMO |
$3.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3.21
|
| Rate for Payer: United Healthcare HMO Rider |
$348.57
|
| Rate for Payer: United Healthcare HMO Rider |
$6.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.94
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$17.95
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Adventist Health Commercial |
$3.59
|
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California EPN |
$9.05
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Central Health Plan Commercial |
$14.36
|
| Rate for Payer: Cigna of CA HMO |
$12.56
|
| Rate for Payer: Cigna of CA PPO |
$12.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$7.18
|
| Rate for Payer: Galaxy Health WC |
$15.26
|
| Rate for Payer: Global Benefits Group Commercial |
$10.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$8.97
|
| Rate for Payer: Prime Health Services Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.74
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$17.95
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Adventist Health Commercial |
$3.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California EPN |
$7.16
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Central Health Plan Commercial |
$14.36
|
| Rate for Payer: Cigna of CA HMO |
$12.56
|
| Rate for Payer: Cigna of CA PPO |
$12.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$7.18
|
| Rate for Payer: Galaxy Health WC |
$15.26
|
| Rate for Payer: Global Benefits Group Commercial |
$10.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.16
|
| Rate for Payer: InnovAge PACE Commercial |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$8.97
|
| Rate for Payer: Prime Health Services Commercial |
$15.26
|
| Rate for Payer: Riverside University Health System MISP |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.74
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.26
|
| Rate for Payer: Vantage Medical Group Senior |
$15.26
|
|
|
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 |
$0.84 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$195.06
|
| Rate for Payer: Adventist Health Commercial |
$3.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$592.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$829.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$536.41
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California Commercial |
$595.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.16
|
| Rate for Payer: Blue Shield of California EPN |
$389.14
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Cash Price |
$536.42
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$536.42
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$7.19
|
| Rate for Payer: Central Health Plan Commercial |
$780.24
|
| Rate for Payer: Central Health Plan Commercial |
$14.36
|
| Rate for Payer: Cigna of CA HMO |
$12.56
|
| Rate for Payer: Cigna of CA HMO |
$682.71
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$12.56
|
| 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: Dignity Health Commercial/Exchange |
$7.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$829.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$829.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$829.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.12
|
| Rate for Payer: EPIC Health Plan Senior |
$390.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.18
|
| Rate for Payer: Galaxy Health WC |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$15.26
|
| Rate for Payer: Galaxy Health WC |
$829.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10.77
|
| Rate for Payer: Global Benefits Group Commercial |
$585.18
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.77
|
| Rate for Payer: InnovAge PACE Commercial |
$487.65
|
| Rate for Payer: InnovAge PACE Commercial |
$4.50
|
| Rate for Payer: InnovAge PACE Commercial |
$8.97
|
| Rate for Payer: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$650.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$603.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$682.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$682.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Networks By Design Commercial |
$8.97
|
| 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 |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$829.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$15.26
|
| Rate for Payer: Riverside University Health System MISP |
$3.60
|
| Rate for Payer: Riverside University Health System MISP |
$7.18
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Riverside University Health System MISP |
$390.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$585.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.37
|
| 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 |
$6.74
|
| 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 All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$356.28
|
| Rate for Payer: United Healthcare HMO Rider |
$6.42
|
| 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 Select/Navigate/Core |
$319.41
|
| 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 |
$5.88
|
| 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 |
$15.26
|
| 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 |
$15.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$829.00
|
| Rate for Payer: Vantage Medical Group Senior |
$15.26
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$829.00
|
|
|
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 |
$10.20
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Cash Price |
$7.26
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| 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 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 |
$8.35
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Cash Price |
$5.94
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| 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
|
$8.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| 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 Commercial/Exchange |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.31
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$5.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.72
|
| Rate for Payer: InnovAge PACE Commercial |
$5.40
|
| Rate for Payer: InnovAge PACE Commercial |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| 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 Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.92
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.86
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| 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 Commercial/Exchange |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
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 |
$0.74 |
| 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 |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California EPN |
$4.31
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| 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: 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: InnovAge PACE Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.56
|
| Rate for Payer: Molina Healthcare of CA 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
|
$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: Blue Shield of California Commercial |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.54
|
| Rate for Payer: Cash Price |
$4.95
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| 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: 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
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.00
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$7.01
|
| Rate for Payer: Cigna of CA PPO |
$7.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: InnovAge PACE Commercial |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$5.01
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Riverside University Health System MISP |
$4.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.76
|
| Rate for Payer: United Healthcare All Other HMO |
$3.66
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.52
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California Commercial |
$8.35
|
| Rate for Payer: Blue Shield of California EPN |
$5.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$4.40
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| 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 Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2.92
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare HMO Rider |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
|
|
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 |
$0.93 |
| 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 |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.59
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| 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: 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: InnovAge PACE Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
