|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
NDC 50242-091-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$238.51 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.45
|
| Rate for Payer: Blue Shield of California Commercial |
$171.17
|
| Rate for Payer: Blue Shield of California EPN |
$136.93
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.51
|
| Rate for Payer: Dignity Health Senior |
$238.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.69
|
| Rate for Payer: Heritage Provider Network Senior |
$173.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.42
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.24
|
| Rate for Payer: TriValley Medical Group Senior |
$112.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$140.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.51
|
| Rate for Payer: Vantage Medical Group Senior |
$238.51
|
|
|
ENTRECTINIB 100 MG CAPSULE [225690]
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
NDC 50242-091-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$210.45 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.97
|
| Rate for Payer: Heritage Provider Network Senior |
$189.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.15
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
NDC 50242-094-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$210.45 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.97
|
| Rate for Payer: Heritage Provider Network Senior |
$189.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.15
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
|
|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
NDC 50242-094-90
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$238.51 |
| Rate for Payer: Adventist Health Commercial |
$56.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.45
|
| Rate for Payer: Blue Shield of California Commercial |
$171.17
|
| Rate for Payer: Blue Shield of California EPN |
$136.93
|
| Rate for Payer: Cash Price |
$154.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.51
|
| Rate for Payer: Dignity Health Senior |
$238.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.69
|
| Rate for Payer: Heritage Provider Network Senior |
$173.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.42
|
| Rate for Payer: Multiplan Commercial |
$210.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.24
|
| Rate for Payer: TriValley Medical Group Senior |
$112.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$140.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.51
|
| Rate for Payer: Vantage Medical Group Senior |
$238.51
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-3
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-3
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 51754-4250-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Senior |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 0641-6236-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$11.27
|
| Rate for Payer: Blue Shield of California EPN |
$9.02
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.71
|
| Rate for Payer: Dignity Health Senior |
$15.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.44
|
| Rate for Payer: Heritage Provider Network Senior |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.39
|
| Rate for Payer: TriValley Medical Group Senior |
$7.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.71
|
| Rate for Payer: Vantage Medical Group Senior |
$15.71
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$42.56 |
| Rate for Payer: Adventist Health Commercial |
$11.35
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.42
|
| Rate for Payer: Heritage Provider Network Senior |
$38.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$56.75
|
|
|
Service Code
|
NDC 70121-1637-7
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$48.24 |
| Rate for Payer: Adventist Health Commercial |
$11.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.56
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.69
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.24
|
| Rate for Payer: Dignity Health Senior |
$48.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Heritage Provider Network Senior |
$35.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.73
|
| Rate for Payer: Multiplan Commercial |
$42.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.70
|
| Rate for Payer: TriValley Medical Group Senior |
$22.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.24
|
| Rate for Payer: Vantage Medical Group Senior |
$48.24
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$11.27
|
| Rate for Payer: Blue Shield of California EPN |
$9.02
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.71
|
| Rate for Payer: Dignity Health Senior |
$15.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.44
|
| Rate for Payer: Heritage Provider Network Senior |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.39
|
| Rate for Payer: TriValley Medical Group Senior |
$7.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.71
|
| Rate for Payer: Vantage Medical Group Senior |
$15.71
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-95
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.51
|
| Rate for Payer: Heritage Provider Network Senior |
$12.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$18.48
|
|
|
Service Code
|
NDC 0781-3269-71
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.51
|
| Rate for Payer: Heritage Provider Network Senior |
$12.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.86
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: Dignity Health Senior |
$2.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 42023-243-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: Dignity Health Senior |
$2.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 42023-243-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-07
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION [227763]
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
NDC 14789-250-07
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.96
|
| Rate for Payer: Dignity Health Senior |
$2.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.39
|
| Rate for Payer: TriValley Medical Group Senior |
$1.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.96
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.76
|
| Rate for Payer: Heritage Provider Network Senior |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.55
|
|
