|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Blue Shield of California Commercial |
$135.00
|
| Rate for Payer: Blue Shield of California EPN |
$96.12
|
| 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: 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: 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
|
|
|
EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC4080665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.01
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$10.00
|
| 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
|
|
|
EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC4080665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.25
|
| 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 |
$9.00
|
| 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 |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| 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: Riverside University Health 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 |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]
|
Facility
OP
|
$0.55
|
|
|
Service Code
|
NDC 69374-925-10
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| 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: Riverside University Health 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 |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| 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
|
NDC 69374-925-10
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: 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
|
|
|
EPINEPHRINE 1 MG/10 ML SYRINGE - CODE [4080580]
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
|
|
EPINEPHRINE 1 MG/10 ML SYRINGE - CODE [4080580]
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| 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 |
$0.71
|
| 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 |
$0.53
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: Central Health Plan Commercial |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.47
|
| Rate for Payer: Galaxy Health WC |
$1.00
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$1.00
|
| Rate for Payer: Riverside University Health MISP |
$0.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.00
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
IP
|
$17.95
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Blue Shield of California Commercial |
$13.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.59
|
| Rate for Payer: Cash Price |
$8.08
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$3.59
|
| Rate for Payer: Multiplan Commercial |
$13.46
|
| Rate for Payer: Networks By Design Commercial |
$8.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.26
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
OP
|
$17.95
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1720457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.87
|
| 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 |
$10.77
|
| 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 |
$8.08
|
| Rate for Payer: Cash Price |
$8.08
|
| 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: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.46
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.97
|
| 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 |
$8.98
|
| Rate for Payer: Prime Health Services Commercial |
$15.26
|
| Rate for Payer: Riverside University Health 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 |
$8.98
|
| Rate for Payer: United Healthcare All Other HMO |
$8.98
|
| Rate for Payer: United Healthcare HMO Rider |
$8.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.98
|
| 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
|
$975.30
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$877.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$829.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$536.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$536.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.90
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: BCBS Transplant Transplant |
$5.39
|
| Rate for Payer: BCBS Transplant Transplant |
$7.92
|
| Rate for Payer: BCBS Transplant Transplant |
$585.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$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: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$438.89
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$438.89
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$780.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.19
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$682.71
|
| Rate for Payer: Cigna of CA PPO |
$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 |
$829.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$390.12
|
| Rate for Payer: Galaxy Health WC |
$829.00
|
| Rate for Payer: Galaxy Health WC |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$585.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$731.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.74
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| 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 |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.06
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$487.65
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Prime Health Services Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$829.00
|
| Rate for Payer: Riverside University Health MISP |
$3.60
|
| Rate for Payer: Riverside University Health MISP |
$390.12
|
| Rate for Payer: Riverside University Health MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$585.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.65
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$487.65
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$487.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$487.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$829.00
|
| 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 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
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$731.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Blue Shield of California EPN |
$520.81
|
| Rate for Payer: Cash Price |
$438.89
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$780.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.19
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$682.71
|
| Rate for Payer: Cigna of CA PPO |
$682.71
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| 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 Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$390.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.60
|
| 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 |
$585.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.77
|
| 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 |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.06
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$487.65
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$829.00
|
| Rate for Payer: Prime Health Services Commercial |
$7.64
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1759134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Blue Shield of California Commercial |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: 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
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
OP
|
$10.80
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDG2850B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.94
|
| 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 |
$6.48
|
| 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 |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$8.10
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| 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: Riverside University Health 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 |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.40
|
| Rate for Payer: United Healthcare HMO Rider |
$5.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
IP
|
$10.80
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDG2850B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Blue Shield of California Commercial |
$8.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.77
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Central Health Plan Commercial |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$7.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: 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
|
|
|
EPINEPHRINE 1 MG/ML INJECTION SOLUTION [2850]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1759134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| 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 |
$5.40
|
| 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 |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$6.75
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.00
|
| 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: Riverside University Health 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 |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7.65
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION [19604]
|
Facility
OP
|
$10.02
|
|
|
Service Code
|
NDC 42023-103-01
|
| Hospital Charge Code |
1743059
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.92
|
| Rate for Payer: BCBS Transplant Transplant |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.90
|
| Rate for Payer: Cash Price |
$4.51
|
| 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: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7.52
|
| Rate for Payer: IEHP medi-cal |
$3.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: Riverside University Health 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 |
$5.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.01
|
| Rate for Payer: United Healthcare HMO Rider |
$5.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.52
|
|
|
EPINEPHRINE 1 MG/ML NASAL SOLUTION [19604]
|
Facility
IP
|
$10.02
|
|
|
Service Code
|
NDC 42023-103-01
|
| Hospital Charge Code |
1743059
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.35
|
| Rate for Payer: Cash Price |
$4.51
|
| 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: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
EPINEPHRINE 2.5 MG/50 ML NS SYRINGE [4080666]
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC4080666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.25
|
| 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 |
$9.00
|
| 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 |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| 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: Riverside University Health 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 |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
EPINEPHRINE 2.5 MG/50 ML NS SYRINGE [4080666]
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC4080666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.01
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$10.00
|
| 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
|
|
|
EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE [220347]
|
Facility
IP
|
$0.79
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDG220347A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
|
|
EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE [220347]
|
Facility
OP
|
$0.79
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDG220347A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| 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 |
$0.47
|
| 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 |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
IP
|
$0.02
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1712561
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
|
|
EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE [211782]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1712561
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Riverside University Health MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
OP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| 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 |
$7.92
|
| 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 |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: IEHP medi-cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| 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: Riverside University Health 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 |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [118405]
|
Facility
IP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: 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
|
|
