|
ENTRECTINIB 200 MG CAPSULE [225691]
|
Facility
|
IP
|
$294.63
|
|
|
Service Code
|
NDC 5024209490
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$220.97 |
| Rate for Payer: Adventist Health Commercial |
$58.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.74
|
| Rate for Payer: Cash Price |
$132.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.46
|
| Rate for Payer: Heritage Provider Network Senior |
$199.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.66
|
| Rate for Payer: Multiplan Commercial |
$220.97
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
|
OP
|
$25,719.24
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$19,289.43 |
| Rate for Payer: Adventist Health Commercial |
$5,143.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,894.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.03
|
| Rate for Payer: Blue Shield of California Commercial |
$53.86
|
| Rate for Payer: Blue Shield of California EPN |
$53.86
|
| Rate for Payer: Cash Price |
$11,573.66
|
| Rate for Payer: Cash Price |
$11,573.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,830.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,460.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$57.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,908.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,908.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,268.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,655.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,429.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.71
|
| Rate for Payer: Multiplan Commercial |
$19,289.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,287.70
|
| Rate for Payer: TriValley Medical Group Senior |
$10,287.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,292.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,515.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Vantage Medical Group Senior |
$63.79
|
|
|
EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION [238112]
|
Facility
|
IP
|
$25,719.24
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,655.18 |
| Max. Negotiated Rate |
$19,289.43 |
| Rate for Payer: Adventist Health Commercial |
$5,143.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,563.19
|
| Rate for Payer: Cash Price |
$11,573.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,830.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,888.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,908.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,908.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,655.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,429.81
|
| Rate for Payer: Multiplan Commercial |
$19,289.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,292.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,515.64
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION [238113]
|
Facility
|
OP
|
$2,143.28
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$1,607.46 |
| Rate for Payer: Adventist Health Commercial |
$428.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.03
|
| Rate for Payer: Blue Shield of California Commercial |
$53.86
|
| Rate for Payer: Blue Shield of California EPN |
$53.86
|
| Rate for Payer: Cash Price |
$964.48
|
| Rate for Payer: Cash Price |
$964.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$985.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,371.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$57.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.34
|
| Rate for Payer: Heritage Provider Network Senior |
$992.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,022.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.71
|
| Rate for Payer: Multiplan Commercial |
$1,607.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$857.31
|
| Rate for Payer: TriValley Medical Group Senior |
$857.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$774.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$709.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.79
|
| Rate for Payer: Vantage Medical Group Senior |
$63.79
|
|
|
EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION [238113]
|
Facility
|
IP
|
$2,143.28
|
|
|
Service Code
|
HCPCS J9321
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$387.93 |
| Max. Negotiated Rate |
$1,607.46 |
| Rate for Payer: Adventist Health Commercial |
$428.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,380.27
|
| Rate for Payer: Cash Price |
$964.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$985.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,157.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.34
|
| Rate for Payer: Heritage Provider Network Senior |
$992.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.82
|
| Rate for Payer: Multiplan Commercial |
$1,607.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$774.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$709.64
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.91
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.98
|
|
|
EPHEDRINE SULFATE 25 MG/5 ML (5 MG/ML) INTRAVENOUS SYRINGE [233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.83
|
| 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 |
$1.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$1.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.98
|
| 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 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5.86
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [214342]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.18
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION WRAP. [408233841]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.83
|
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.57
|
| 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 Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.90
|
| Rate for Payer: TriValley Medical Group Senior |
$1.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| 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 Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2.52
|
|
|
EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION WRAP. [408233841]
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Adventist Health Commercial |
$0.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.07
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.98
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Senior |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.54
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE (10 ML) [2848]
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.17
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Senior |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$109.80
|
| Rate for Payer: Blue Shield of California EPN |
$87.84
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.34
|
| Rate for Payer: Heritage Provider Network Senior |
$83.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [100491]
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.92
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.34
|
| Rate for Payer: Heritage Provider Network Senior |
$83.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$65.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.60
|
|
|
EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$7.32
|
| 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 Medicare Advantage |
$12.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
EPINEPHRINE 1.25 MG/50 ML NS SYRINGE [4080665]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| 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 |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| 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 |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
|
|
EPINEPHRINE 1 MG/10 ML (100 MCG/ML) IN SODIUM CHLOR,ISO-OSM IV SYRINGE [224815]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| 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: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Vantage Medical Group Senior |
$0.47
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$975.30
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$829.00 |
| Rate for Payer: Adventist Health Commercial |
$195.06
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$602.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$829.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$536.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$731.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$8.05
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Blue Shield of California EPN |
$475.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$438.88
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$438.88
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$448.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$829.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$829.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$829.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$451.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$451.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.16
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$465.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$682.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$390.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3.94
|
| Rate for Payer: TriValley Medical Group Senior |
$390.12
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$352.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$322.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$829.00
|
| 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 |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$829.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7.64
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$975.30
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.53 |
| Max. Negotiated Rate |
$731.48 |
| Rate for Payer: Adventist Health Commercial |
$195.06
|
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.34
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$438.88
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$448.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$451.56
|
| Rate for Payer: Heritage Provider Network Senior |
$451.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4.16
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$731.48
|
| Rate for Payer: Multiplan Commercial |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$352.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$322.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.26
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$9.84
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.34
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.26
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
OP
|
$9.84
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.00
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Vantage Medical Group Senior |
$8.36
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION WRAP [408187508]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
901700025
|
|
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 |
$8.50
|
| 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 |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$4.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
|
