|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
IP
|
$28.54
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Adventist Health Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$21.06
|
| Rate for Payer: Blue Shield of California EPN |
$13.87
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cigna of CA HMO |
$19.98
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Senior |
$11.42
|
| Rate for Payer: Galaxy Health WC |
$24.26
|
| Rate for Payer: Global Benefits Group Commercial |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$22.83
|
| Rate for Payer: Networks By Design Commercial |
$18.55
|
| Rate for Payer: Prime Health Services Commercial |
$24.26
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
OP
|
$28.54
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Adventist Health Commercial |
$5.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.53
|
| Rate for Payer: Cash Price |
$15.70
|
| Rate for Payer: Cigna of CA HMO |
$19.98
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Senior |
$11.42
|
| Rate for Payer: Galaxy Health WC |
$24.26
|
| Rate for Payer: Global Benefits Group Commercial |
$17.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.98
|
| Rate for Payer: Multiplan Commercial |
$22.83
|
| Rate for Payer: Networks By Design Commercial |
$18.55
|
| Rate for Payer: Prime Health Services Commercial |
$24.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.27
|
| Rate for Payer: United Healthcare All Other HMO |
$14.27
|
| Rate for Payer: United Healthcare HMO Rider |
$14.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.26
|
| Rate for Payer: Vantage Medical Group Senior |
$24.26
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.88
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.90
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.77
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.45
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Senior |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$3.26
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.32
|
| Rate for Payer: Blue Shield of California Commercial |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cigna of CA HMO |
$5.41
|
| Rate for Payer: Cigna of CA PPO |
$5.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.09
|
| Rate for Payer: EPIC Health Plan Senior |
$3.09
|
| Rate for Payer: Galaxy Health WC |
$6.57
|
| Rate for Payer: Global Benefits Group Commercial |
$4.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$6.18
|
| Rate for Payer: Networks By Design Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$6.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.57
|
| Rate for Payer: Vantage Medical Group Senior |
$6.57
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cigna of CA HMO |
$5.41
|
| Rate for Payer: Cigna of CA PPO |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.09
|
| Rate for Payer: EPIC Health Plan Senior |
$3.09
|
| Rate for Payer: Galaxy Health WC |
$6.57
|
| Rate for Payer: Global Benefits Group Commercial |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$6.18
|
| Rate for Payer: Networks By Design Commercial |
$3.87
|
| Rate for Payer: Prime Health Services Commercial |
$6.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.53
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
IP
|
$357.48
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$303.86 |
| Rate for Payer: Adventist Health Commercial |
$71.50
|
| Rate for Payer: Blue Shield of California Commercial |
$263.82
|
| Rate for Payer: Blue Shield of California EPN |
$173.74
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$250.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.99
|
| Rate for Payer: EPIC Health Plan Senior |
$142.99
|
| Rate for Payer: Galaxy Health WC |
$303.86
|
| Rate for Payer: Global Benefits Group Commercial |
$214.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$285.98
|
| Rate for Payer: Networks By Design Commercial |
$178.74
|
| Rate for Payer: Prime Health Services Commercial |
$303.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.16
|
| Rate for Payer: United Healthcare All Other HMO |
$130.59
|
| Rate for Payer: United Healthcare HMO Rider |
$127.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.07
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
OP
|
$357.48
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$303.86 |
| Rate for Payer: Adventist Health Commercial |
$71.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.18
|
| Rate for Payer: Blue Shield of California Commercial |
$81.10
|
| Rate for Payer: Blue Shield of California EPN |
$81.10
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$250.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.09
|
| Rate for Payer: EPIC Health Plan Senior |
$65.25
|
| Rate for Payer: Galaxy Health WC |
$303.86
|
| Rate for Payer: Global Benefits Group Commercial |
$214.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.44
|
| Rate for Payer: Multiplan Commercial |
$285.98
|
| Rate for Payer: Networks By Design Commercial |
$178.74
|
| Rate for Payer: Prime Health Services Commercial |
$303.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.16
|
| Rate for Payer: United Healthcare All Other HMO |
$130.59
|
| Rate for Payer: United Healthcare HMO Rider |
$127.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: Vantage Medical Group Senior |
$71.78
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$19.01 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Blue Shield of California Commercial |
$16.51
|
| Rate for Payer: Blue Shield of California EPN |
$10.87
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cigna of CA HMO |
$15.66
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.01
|
| Rate for Payer: Global Benefits Group Commercial |
$13.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Multiplan Commercial |
$17.90
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$19.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.17
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.33
|
|
