|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$13.37
|
|
|
Service Code
|
NDC 70756-611-82
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Blue Shield of California Commercial |
$10.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.14
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$13.37
|
|
|
Service Code
|
NDC 70756-611-25
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Blue Shield of California Commercial |
$10.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.14
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$9.35
|
|
|
Service Code
|
NDC 70700-249-25
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$14.96
|
|
|
Service Code
|
NDC 70700-249-22
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.84
|
| Rate for Payer: BCBS Transplant Transplant |
$8.98
|
| Rate for Payer: Blue Shield of California Commercial |
$9.41
|
| Rate for Payer: Blue Shield of California EPN |
$7.32
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Central Health Plan Commercial |
$11.97
|
| Rate for Payer: Cigna of CA HMO |
$9.57
|
| Rate for Payer: Cigna of CA PPO |
$11.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.98
|
| Rate for Payer: Galaxy Health WC |
$12.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.22
|
| Rate for Payer: IEHP medi-cal |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$11.22
|
| Rate for Payer: Networks By Design Commercial |
$9.72
|
| Rate for Payer: Prime Health Services Commercial |
$12.72
|
| Rate for Payer: Riverside University Health MISP |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO |
$7.48
|
| Rate for Payer: United Healthcare HMO Rider |
$7.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.72
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$14.96
|
|
|
Service Code
|
NDC 70700-249-22
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Blue Shield of California Commercial |
$11.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.99
|
| Rate for Payer: Cash Price |
$6.73
|
| Rate for Payer: Central Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.98
|
| Rate for Payer: Galaxy Health WC |
$12.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$11.22
|
| Rate for Payer: Networks By Design Commercial |
$9.72
|
| Rate for Payer: Prime Health Services Commercial |
$12.72
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.12
|
| Rate for Payer: BCBS Transplant Transplant |
$20.43
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.65
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Central Health Plan Commercial |
$27.24
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.54
|
| Rate for Payer: IEHP medi-cal |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.54
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
| Rate for Payer: Riverside University Health MISP |
$13.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO |
$17.02
|
| Rate for Payer: United Healthcare HMO Rider |
$17.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.94
|
| Rate for Payer: Vantage Medical Group Senior |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$13.37
|
|
|
Service Code
|
NDC 70756-611-82
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.90
|
| Rate for Payer: BCBS Transplant Transplant |
$8.02
|
| Rate for Payer: Blue Shield of California Commercial |
$8.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.54
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$9.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.03
|
| Rate for Payer: IEHP medi-cal |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
| Rate for Payer: Riverside University Health MISP |
$5.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.68
|
| Rate for Payer: United Healthcare HMO Rider |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.36
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.53
|
| Rate for Payer: BCBS Transplant Transplant |
$34.05
|
| Rate for Payer: Blue Shield of California Commercial |
$35.70
|
| Rate for Payer: Blue Shield of California EPN |
$27.75
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Central Health Plan Commercial |
$45.40
|
| Rate for Payer: Cigna of CA HMO |
$36.32
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.56
|
| Rate for Payer: IEHP medi-cal |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
| Rate for Payer: Riverside University Health MISP |
$22.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.38
|
| Rate for Payer: United Healthcare All Other HMO |
$28.38
|
| Rate for Payer: United Healthcare HMO Rider |
$28.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.24
|
| Rate for Payer: Vantage Medical Group Senior |
$48.24
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$34.85
|
|
|
Service Code
|
NDC 70121-1637-1
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.59
|
| Rate for Payer: BCBS Transplant Transplant |
$20.91
|
| Rate for Payer: Blue Shield of California Commercial |
$21.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.04
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Central Health Plan Commercial |
$27.88
|
| Rate for Payer: Cigna of CA HMO |
$22.30
|
| Rate for Payer: Cigna of CA PPO |
$25.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.94
|
| Rate for Payer: Galaxy Health WC |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.14
|
| Rate for Payer: IEHP medi-cal |
$12.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$26.14
|
| Rate for Payer: Networks By Design Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Commercial |
$29.62
|
| Rate for Payer: Riverside University Health MISP |
$13.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.42
|
| Rate for Payer: United Healthcare All Other HMO |
$17.42
|
| Rate for Payer: United Healthcare HMO Rider |
$17.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.62
|
| Rate for Payer: Vantage Medical Group Senior |
$29.62
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Blue Shield of California Commercial |
$25.54
|
| Rate for Payer: Blue Shield of California EPN |
$18.18
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Central Health Plan Commercial |
$27.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.54
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$5.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: BCBS Transplant Transplant |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.88
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Central Health Plan Commercial |
$7.48
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$6.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.01
|
| Rate for Payer: IEHP medi-cal |
$3.27
|
| 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
|
| Rate for Payer: Riverside University Health MISP |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
OP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.12
|
| Rate for Payer: BCBS Transplant Transplant |
$20.43
|
| Rate for Payer: Blue Shield of California Commercial |
$21.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.65
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Central Health Plan Commercial |
$27.24
|
| Rate for Payer: Cigna of CA HMO |
$21.79
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.54
|
| Rate for Payer: IEHP medi-cal |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.54
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
| Rate for Payer: Riverside University Health MISP |
$13.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO |
$17.02
|
| Rate for Payer: United Healthcare HMO Rider |
$17.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.94
|
| Rate for Payer: Vantage Medical Group Senior |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$34.85
|
|
|
Service Code
|
NDC 70121-1637-1
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Blue Shield of California Commercial |
$26.14
|
| Rate for Payer: Blue Shield of California EPN |
$18.61
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Central Health Plan Commercial |
$27.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.94
|
| Rate for Payer: Galaxy Health WC |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$26.14
|
| Rate for Payer: Networks By Design Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Commercial |
$29.62
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$34.05
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Blue Shield of California Commercial |
$25.54
|
| Rate for Payer: Blue Shield of California EPN |
$18.18
|
| Rate for Payer: Cash Price |
$15.32
|
| Rate for Payer: Central Health Plan Commercial |
$27.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.94
|
| Rate for Payer: Global Benefits Group Commercial |
$20.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$25.54
|
| Rate for Payer: Networks By Design Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$28.94
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
IP
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
1720234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Blue Shield of California Commercial |
$42.56
|
| Rate for Payer: Blue Shield of California EPN |
$30.30
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Central Health Plan Commercial |
$45.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.24
|
| Rate for Payer: Global Benefits Group Commercial |
$34.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: Networks By Design Commercial |
$36.89
|
| Rate for Payer: Prime Health Services Commercial |
$48.24
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
OP
|
$3.48
|
|
|
Service Code
|
NDC 42023-243-01
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: BCBS Transplant Transplant |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cash Price |
$1.57
|
| 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: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.61
|
| Rate for Payer: IEHP medi-cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| 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
|
| Rate for Payer: Riverside University Health 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 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 |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Blue Shield of California Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| 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 |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.06
|
| Rate for Payer: BCBS Transplant Transplant |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cash Price |
$1.57
|
| 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: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.61
|
| Rate for Payer: IEHP medi-cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| 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
|
| Rate for Payer: Riverside University Health 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 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 14789-250-07
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Blue Shield of California Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Central Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
| Rate for Payer: Networks By Design Commercial |
$2.26
|
| Rate for Payer: Prime Health Services Commercial |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
NDC 14789-250-10
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 14789-250-10
|
| Hospital Charge Code |
NDG227763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.99
|
| Rate for Payer: BCBS Transplant Transplant |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.15
|
| Rate for Payer: Cigna of CA PPO |
$2.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.34
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.52
|
| Rate for Payer: IEHP medi-cal |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Networks By Design Commercial |
$2.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Riverside University Health MISP |
$1.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO |
$1.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
|
|
Epididymectomy; unilateral
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 54860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| 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 |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
IP
|
$1.50
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
OP
|
$1.50
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.12
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Riverside University Health MISP |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$135.00
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| 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: Riverside University Health 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 |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO |
$90.00
|
| Rate for Payer: United Healthcare HMO Rider |
$90.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
