|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.10
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.10
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-83
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.09
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.11
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
IP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$34.10 |
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$31.97
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$31.97 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$25.58
|
| Rate for Payer: Aetna of CA Government/Medicare |
$25.58
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$25.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$25.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.45
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$31.97
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.86
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.08
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.88
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.10
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.10
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.08
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.73
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.73
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.16
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.75
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.75
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.19
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.19
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.16
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.19
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.19
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.59
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.95
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.43
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.95
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.90
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.33
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.59
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.90
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.59
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.95
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.33
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.59
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.95
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.43
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.12
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION [108138]
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG108138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.82
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION [108138]
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG108138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.82
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$9.95
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.46
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.23
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.78
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.24
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.04
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$9.95
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.47
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.46
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.23
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.47
|
| Rate for Payer: Aetna of CA Government/Medicare |
$9.95
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.78
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.82
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.72
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.83
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.54
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$9.72
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.42
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.44
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
|
IP
|
$8.56
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.85
|
| Rate for Payer: Health Smart Auto/Commercial |
$9.95
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.83
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$9.72
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.82
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.72
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.54
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.42
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
IP
|
$7.07
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG94341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.30
|
|
