|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
IP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.72
|
| 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: 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: 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
|
$2.56
|
|
|
Service Code
|
NDC 69097-426-02
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: BCBS Transplant Transplant |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Central Health Plan Commercial |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.92
|
| Rate for Payer: IEHP medi-cal |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: Riverside University Health MISP |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2.18
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
IP
|
$2.56
|
|
|
Service Code
|
NDC 69097-426-02
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Central Health Plan Commercial |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$1.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.18
|
| Rate for Payer: Global Benefits Group Commercial |
$1.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.18
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
IP
|
$3.14
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Blue Shield of California Commercial |
$2.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Central Health Plan Commercial |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
OP
|
$3.14
|
|
|
Service Code
|
NDC 42806-658-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: BCBS Transplant Transplant |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.54
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Central Health Plan Commercial |
$2.51
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$2.67
|
| Rate for Payer: Global Benefits Group Commercial |
$1.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.36
|
| Rate for Payer: IEHP medi-cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.36
|
| Rate for Payer: Networks By Design Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: Riverside University Health MISP |
$1.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Vantage Medical Group Senior |
$2.67
|
|
|
ENTECAVIR 0.5 MG TABLET [41147]
|
Facility
OP
|
$1.60
|
|
|
Service Code
|
NDC 31722-833-30
|
| Hospital Charge Code |
1711886
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.95
|
| Rate for Payer: BCBS Transplant Transplant |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.72
|
| 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: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.20
|
| Rate for Payer: IEHP medi-cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.96
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$1.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1.36
|
|
|
Enterolysis (freeing of intestinal adhesion) (separate procedure)
|
Facility
OP
|
$9,620.00
|
|
|
Service Code
|
CPT 44005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$9,620.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
IP
|
$254.51
|
|
|
Service Code
|
NDC 50242-091-30
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$229.06 |
| Rate for Payer: Blue Shield of California Commercial |
$190.88
|
| Rate for Payer: Blue Shield of California EPN |
$135.91
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Central Health Plan Commercial |
$203.61
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
OP
|
$254.51
|
|
|
Service Code
|
NDC 50242-091-30
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$229.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$139.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.36
|
| Rate for Payer: BCBS Transplant Transplant |
$152.71
|
| Rate for Payer: Blue Shield of California Commercial |
$160.09
|
| Rate for Payer: Blue Shield of California EPN |
$124.46
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Central Health Plan Commercial |
$203.61
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$190.88
|
| Rate for Payer: IEHP medi-cal |
$89.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
| Rate for Payer: Riverside University Health MISP |
$101.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.26
|
| Rate for Payer: United Healthcare All Other HMO |
$127.26
|
| Rate for Payer: United Healthcare HMO Rider |
$127.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.33
|
| Rate for Payer: Vantage Medical Group Senior |
$216.33
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
OP
|
$254.51
|
|
|
Service Code
|
NDC 50242-094-90
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$229.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$139.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.36
|
| Rate for Payer: BCBS Transplant Transplant |
$152.71
|
| Rate for Payer: Blue Shield of California Commercial |
$160.09
|
| Rate for Payer: Blue Shield of California EPN |
$124.46
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Central Health Plan Commercial |
$203.61
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$190.88
|
| Rate for Payer: IEHP medi-cal |
$89.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
| Rate for Payer: Riverside University Health MISP |
$101.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.26
|
| Rate for Payer: United Healthcare All Other HMO |
$127.26
|
| Rate for Payer: United Healthcare HMO Rider |
$127.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.33
|
| Rate for Payer: Vantage Medical Group Senior |
$216.33
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
IP
|
$254.51
|
|
|
Service Code
|
NDC 50242-094-90
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$229.06 |
| Rate for Payer: Blue Shield of California Commercial |
$190.88
|
| Rate for Payer: Blue Shield of California EPN |
$135.91
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Central Health Plan Commercial |
$203.61
|
| Rate for Payer: Cigna of CA HMO |
$178.16
|
| Rate for Payer: Cigna of CA PPO |
$178.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.33
|
| Rate for Payer: Global Benefits Group Commercial |
$152.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: Networks By Design Commercial |
$127.26
|
| Rate for Payer: Prime Health Services Commercial |
$216.33
|
|
|
Enucleation of eye; with implant, muscles attached to implant
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 65105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,830.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,830.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,521.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,830.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,922.50
|
| Rate for Payer: IEHP medi-cal |
$7,970.80
|
| Rate for Payer: IEHP Medicare Advantage |
$4,830.79
|
| Rate for Payer: Innovage PACE Commercial |
$7,246.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,830.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,473.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,473.26
|
| Rate for Payer: Prime Health Services Medicare |
$5,120.64
|
| Rate for Payer: Riverside University Health MISP |
$5,313.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
OP
|
$22,838.34
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,567.67 |
| Max. Negotiated Rate |
$20,554.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,869.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19,412.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,561.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,561.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,058.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,492.89
|
| Rate for Payer: BCBS Transplant Transplant |
$13,703.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,365.32
|
| Rate for Payer: Blue Shield of California EPN |
$11,167.95
|
| Rate for Payer: Cash Price |
$10,277.25
|
| Rate for Payer: Cash Price |
$10,277.25
|
| Rate for Payer: Central Health Plan Commercial |
$18,270.67
|
| Rate for Payer: Cigna of CA HMO |
$15,986.84
|
| Rate for Payer: Cigna of CA PPO |
$15,986.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,412.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,135.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,135.34
|
| Rate for Payer: Galaxy Health WC |
$19,412.59
|
| Rate for Payer: Global Benefits Group Commercial |
$13,703.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,554.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17,128.76
|
| Rate for Payer: IEHP medi-cal |
$7,993.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,233.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,567.67
|
| Rate for Payer: Multiplan Commercial |
$17,128.76
|
| Rate for Payer: Networks By Design Commercial |
$11,419.17
|
| Rate for Payer: Prime Health Services Commercial |
$19,412.59
|
| Rate for Payer: Riverside University Health MISP |
$9,135.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,703.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,703.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,419.17
|
| Rate for Payer: United Healthcare All Other HMO |
$11,419.17
|
| Rate for Payer: United Healthcare HMO Rider |
$11,419.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,419.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,412.59
|
| Rate for Payer: Vantage Medical Group Senior |
$19,412.59
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
IP
|
$22,838.34
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,567.67 |
| Max. Negotiated Rate |
$20,554.51 |
| Rate for Payer: Blue Shield of California Commercial |
$17,128.76
|
| Rate for Payer: Blue Shield of California EPN |
$12,195.67
|
| Rate for Payer: Cash Price |
$10,277.25
|
| Rate for Payer: Central Health Plan Commercial |
$18,270.67
|
| Rate for Payer: Cigna of CA HMO |
$15,986.84
|
| Rate for Payer: Cigna of CA PPO |
$15,986.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,135.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,135.34
|
| Rate for Payer: Galaxy Health WC |
$19,412.59
|
| Rate for Payer: Global Benefits Group Commercial |
$13,703.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,554.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,233.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,567.67
|
| Rate for Payer: Multiplan Commercial |
$17,128.76
|
| Rate for Payer: Networks By Design Commercial |
$11,419.17
|
| Rate for Payer: Prime Health Services Commercial |
$19,412.59
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION (MUST DILUTE) [238113]
|
Facility
OP
|
$1,903.20
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.64 |
| Max. Negotiated Rate |
$1,712.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,155.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,617.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,046.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,046.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$921.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1,141.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.11
|
| Rate for Payer: Blue Shield of California EPN |
$930.66
|
| Rate for Payer: Cash Price |
$856.44
|
| Rate for Payer: Cash Price |
$856.44
|
| Rate for Payer: Central Health Plan Commercial |
$1,522.56
|
| Rate for Payer: Cigna of CA HMO |
$1,332.24
|
| Rate for Payer: Cigna of CA PPO |
$1,332.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,617.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$761.28
|
| Rate for Payer: Galaxy Health WC |
$1,617.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,141.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,712.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,427.40
|
| Rate for Payer: IEHP medi-cal |
$666.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.64
|
| Rate for Payer: Multiplan Commercial |
$1,427.40
|
| Rate for Payer: Networks By Design Commercial |
$951.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,617.72
|
| Rate for Payer: Riverside University Health MISP |
$761.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,141.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,141.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.60
|
| Rate for Payer: United Healthcare All Other HMO |
$951.60
|
| Rate for Payer: United Healthcare HMO Rider |
$951.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,617.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1,617.72
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION (MUST DILUTE) [238113]
|
Facility
IP
|
$1,903.20
|
|
|
Service Code
|
CPT C9155
|
| Hospital Charge Code |
ERX238113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.64 |
| Max. Negotiated Rate |
$1,712.88 |
| Rate for Payer: Blue Shield of California Commercial |
$1,427.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,016.31
|
| Rate for Payer: Cash Price |
$856.44
|
| Rate for Payer: Central Health Plan Commercial |
$1,522.56
|
| Rate for Payer: Cigna of CA HMO |
$1,332.24
|
| Rate for Payer: Cigna of CA PPO |
$1,332.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$761.28
|
| Rate for Payer: Galaxy Health WC |
$1,617.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1,141.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,712.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.64
|
| Rate for Payer: Multiplan Commercial |
$1,427.40
|
| Rate for Payer: Networks By Design Commercial |
$951.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,617.72
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
OP
|
$4.76
|
|
|
Service Code
|
NDC 70092-1478-44
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: BCBS Transplant Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.57
|
| Rate for Payer: IEHP medi-cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Riverside University Health MISP |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 70004-604-09
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: BCBS Transplant Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.50
|
| Rate for Payer: IEHP medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Riverside University Health MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 70004-604-09
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Blue Shield of California Commercial |
$4.50
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM CHLORIDE IV SYRINGE [120232]
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 70092-1478-44
|
| Hospital Charge Code |
1722051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
OP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-3
|
| Hospital Charge Code |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: BCBS Transplant Transplant |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| 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: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.22
|
| Rate for Payer: IEHP medi-cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| 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
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
IP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-1
|
| Hospital Charge Code |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| 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 |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Central Health Plan Commercial |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| 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 |
NDG233841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: BCBS Transplant Transplant |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$1.33
|
| 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: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.18
|
| Rate for Payer: Galaxy Health WC |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.22
|
| Rate for Payer: IEHP medi-cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.97
|
| 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
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$9.35
|
|
|
Service Code
|
NDC 70700-249-25
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Blue Shield of California Commercial |
$7.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.99
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Central Health Plan Commercial |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.01
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
|
