|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
IP
|
$179.90
|
|
|
Service Code
|
NDC 66215-302-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Adventist Health Commercial |
$35.98
|
| Rate for Payer: Blue Shield of California Commercial |
$132.77
|
| Rate for Payer: Blue Shield of California EPN |
$87.43
|
| Rate for Payer: Cash Price |
$98.95
|
| Rate for Payer: Cigna of CA HMO |
$125.93
|
| Rate for Payer: Cigna of CA PPO |
$125.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.96
|
| Rate for Payer: EPIC Health Plan Senior |
$71.96
|
| Rate for Payer: Galaxy Health WC |
$152.91
|
| Rate for Payer: Global Benefits Group Commercial |
$107.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.18
|
| Rate for Payer: Multiplan Commercial |
$143.92
|
| Rate for Payer: Networks By Design Commercial |
$116.94
|
| Rate for Payer: Prime Health Services Commercial |
$152.91
|
|
|
ILOPROST 10 MCG/ML SOLUTION FOR NEBULIZATION [40413]
|
Facility
|
OP
|
$179.92
|
|
|
Service Code
|
NDC 66215-302-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$152.93 |
| Rate for Payer: Adventist Health Commercial |
$35.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Cash Price |
$98.95
|
| Rate for Payer: Cigna of CA HMO |
$125.94
|
| Rate for Payer: Cigna of CA PPO |
$125.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.97
|
| Rate for Payer: EPIC Health Plan Senior |
$71.97
|
| Rate for Payer: Galaxy Health WC |
$152.93
|
| Rate for Payer: Global Benefits Group Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Networks By Design Commercial |
$116.95
|
| Rate for Payer: Prime Health Services Commercial |
$152.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$89.96
|
| Rate for Payer: United Healthcare HMO Rider |
$89.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.93
|
| Rate for Payer: Vantage Medical Group Senior |
$152.93
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
OP
|
$179.90
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Adventist Health Commercial |
$35.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.48
|
| Rate for Payer: Cash Price |
$98.95
|
| Rate for Payer: Cigna of CA HMO |
$125.93
|
| Rate for Payer: Cigna of CA PPO |
$125.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.96
|
| Rate for Payer: EPIC Health Plan Senior |
$71.96
|
| Rate for Payer: Galaxy Health WC |
$152.91
|
| Rate for Payer: Global Benefits Group Commercial |
$107.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.93
|
| Rate for Payer: Multiplan Commercial |
$143.92
|
| Rate for Payer: Networks By Design Commercial |
$116.94
|
| Rate for Payer: Prime Health Services Commercial |
$152.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.95
|
| Rate for Payer: United Healthcare All Other HMO |
$89.95
|
| Rate for Payer: United Healthcare HMO Rider |
$89.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.91
|
| Rate for Payer: Vantage Medical Group Senior |
$152.91
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
IP
|
$179.90
|
|
|
Service Code
|
NDC 66215-303-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Adventist Health Commercial |
$35.98
|
| Rate for Payer: Blue Shield of California Commercial |
$132.77
|
| Rate for Payer: Blue Shield of California EPN |
$87.43
|
| Rate for Payer: Cash Price |
$98.95
|
| Rate for Payer: Cigna of CA HMO |
$125.93
|
| Rate for Payer: Cigna of CA PPO |
$125.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.96
|
| Rate for Payer: EPIC Health Plan Senior |
$71.96
|
| Rate for Payer: Galaxy Health WC |
$152.91
|
| Rate for Payer: Global Benefits Group Commercial |
$107.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.18
|
| Rate for Payer: Multiplan Commercial |
$143.92
|
| Rate for Payer: Networks By Design Commercial |
$116.94
|
| Rate for Payer: Prime Health Services Commercial |
$152.91
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
IP
|
$179.92
|
|
|
Service Code
|
NDC 66215-303-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$152.93 |
| Rate for Payer: Adventist Health Commercial |
$35.98
|
| Rate for Payer: Blue Shield of California Commercial |
$132.78
|
| Rate for Payer: Blue Shield of California EPN |
$87.44
|
| Rate for Payer: Cash Price |
$98.95
|
| Rate for Payer: Cigna of CA HMO |
$125.94
|
| Rate for Payer: Cigna of CA PPO |
$125.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.97
|
| Rate for Payer: EPIC Health Plan Senior |
$71.97
|
| Rate for Payer: Galaxy Health WC |
$152.93
|
| Rate for Payer: Global Benefits Group Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.18
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Networks By Design Commercial |
$116.95
|
| Rate for Payer: Prime Health Services Commercial |
$152.93
|
|
|
ILOPROST 20 MCG/ML SOLUTION FOR NEBULIZATION [99773]
|
Facility
|
OP
|
$179.92
|
|
|
Service Code
|
NDC 66215-303-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$152.93 |
| Rate for Payer: Adventist Health Commercial |
$35.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.49
|
| Rate for Payer: Cash Price |
$98.95
|
| Rate for Payer: Cigna of CA HMO |
$125.94
|
| Rate for Payer: Cigna of CA PPO |
$125.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.97
|
| Rate for Payer: EPIC Health Plan Senior |
$71.97
|
| Rate for Payer: Galaxy Health WC |
$152.93
|
| Rate for Payer: Global Benefits Group Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$125.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$125.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Networks By Design Commercial |
$116.95
|
| Rate for Payer: Prime Health Services Commercial |
$152.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$89.96
|
| Rate for Payer: United Healthcare HMO Rider |
$89.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.93
|
| Rate for Payer: Vantage Medical Group Senior |
$152.93
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
|
|
IMATINIB 100 MG TABLET [32979]
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$8.06 |
| Rate for Payer: Adventist Health Commercial |
$0.39
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$1.38
|
| Rate for Payer: Cigna of CA PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.79
|
| Rate for Payer: Galaxy Health WC |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.58
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$1.25
|
| Rate for Payer: Prime Health Services Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$2.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1.67
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.53
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Networks By Design Commercial |
$3.38
|
| Rate for Payer: Prime Health Services Commercial |
$4.42
|
|
|
IMATINIB 400 MG TABLET [36092]
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
HCPCS S0088
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$8.06 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$3.64
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Senior |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.42
|
| Rate for Payer: Global Benefits Group Commercial |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Networks By Design Commercial |
$3.38
|
| Rate for Payer: Prime Health Services Commercial |
$4.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4.42
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
IP
|
$20.51
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Blue Shield of California Commercial |
$15.14
|
| Rate for Payer: Blue Shield of California EPN |
$9.97
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$10.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
|
|
IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION [9602]
|
Facility
|
OP
|
$20.51
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$29.65 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.65
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cigna of CA HMO |
$14.36
|
| Rate for Payer: Cigna of CA PPO |
$14.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.36
|
| Rate for Payer: Multiplan Commercial |
$16.41
|
| Rate for Payer: Networks By Design Commercial |
$10.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.43
|
| Rate for Payer: Vantage Medical Group Senior |
$17.43
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.58 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California Commercial |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$24.22
|
| Rate for Payer: Blue Shield of California EPN |
$15.95
|
| Rate for Payer: Blue Shield of California EPN |
$17.49
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Senior |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$12.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.78
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION [9603]
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.58 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.65
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Blue Shield of California EPN |
$12.85
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$22.97
|
| Rate for Payer: Cigna of CA PPO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$22.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$13.13
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$30.58
|
| Rate for Payer: Galaxy Health WC |
$27.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.59
|
| Rate for Payer: Global Benefits Group Commercial |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.97
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Multiplan Commercial |
$26.26
|
| Rate for Payer: Networks By Design Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$16.41
|
| Rate for Payer: Prime Health Services Commercial |
$27.90
|
| Rate for Payer: Prime Health Services Commercial |
$30.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.86
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.90
|
| Rate for Payer: Vantage Medical Group Senior |
$30.58
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 69584-425-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 69584-425-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.06
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Vantage Medical Group Senior |
$0.06
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
|
|
IMIPRAMINE 10 MG TABLET [3860]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 69315-133-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Vantage Medical Group Senior |
$0.19
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 69584-426-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 69315-134-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 69315-134-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
IMIPRAMINE 25 MG TABLET [3861]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 69584-426-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-62
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
|
IMIQUIMOD 5 % TOPICAL CREAM PACKET [20718]
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 45802-368-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.75
|
| Rate for Payer: Cigna of CA PPO |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1.00
|
| Rate for Payer: Galaxy Health WC |
$2.12
|
| Rate for Payer: Global Benefits Group Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.00
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.12
|
|
