|
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 |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.01
|
|
|
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 |
$0.65 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| 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 |
$6.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.65
|
| Rate for Payer: Dignity Health Senior |
$7.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.17
|
| Rate for Payer: IEHP Medi-Cal |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.01
|
| 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 |
$1.81 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| 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 |
$7.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.52
|
| Rate for Payer: Dignity Health Senior |
$8.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
| 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 |
$1.81 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.52
|
|
|
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 |
$0.65 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| 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 |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Senior |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6.94
|
| Rate for Payer: IEHP Medi-Cal |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.01
|
| 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 |
$2.72 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.01
|
|
|
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 |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
|
|
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 |
$0.14 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| 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 |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: IEHP Medi-Cal |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.26
|
| 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
OP
|
$0.02
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
1712561
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| 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 |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: Dignity Health Senior |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: IEHP Medi-Cal |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
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: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
|
|
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 |
$0.65 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| 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 |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: IEHP Medi-Cal |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
| 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 |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
IP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
|
|
EPINEPHRINE (PF) 1 MG/ML (1:1,000) (1 ML) INJECTION FOR DRIPS [4080899]
|
Facility
OP
|
$13.20
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
NDC259881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| 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 |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: IEHP Medi-Cal |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 25450
|
| Min. Negotiated Rate |
$536.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$536.66
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,044.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION [88009]
|
Facility
OP
|
$2.32
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
NDG88009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.97
|
| Rate for Payer: Dignity Health Senior |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1.07
|
| Rate for Payer: IEHP Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.97
|
|
|
EPIRUBICIN 200 MG/100 ML INTRAVENOUS SOLUTION [88009]
|
Facility
IP
|
$2.32
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
NDG88009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.59
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.78
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
OP
|
$2.24
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
1755705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Senior |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: IEHP Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION [88008]
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
1755705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.54
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
|
|
EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]
|
Facility
IP
|
$46.25
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
ERX76923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Adventist Health Commercial |
$9.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.77
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.31
|
| Rate for Payer: Heritage Provider Network Senior |
$31.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$34.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.45
|
|
|
EPIRUBICIN 50 MG INTRAVENOUS SOLUTION [76923]
|
Facility
OP
|
$46.25
|
|
|
Service Code
|
CPT J9178
|
| Hospital Charge Code |
ERX76923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Adventist Health Commercial |
$9.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California EPN |
$1.59
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Senior |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.41
|
| Rate for Payer: Heritage Provider Network Senior |
$21.41
|
| Rate for Payer: IEHP Medi-Cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$34.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$39.31
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
NDC 0378-1030-93
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
|
|
EPLERENONE 25 MG TABLET [36983]
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
NDC 16729-293-10
|
| Hospital Charge Code |
1712284
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
