|
IBUPROFEN 600 MG TABLET [3844]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 6438080806
|
| 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 |
$0.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
IBUPROFEN 800 MG/8 ML (100 MG/ML) INTRAVENOUS SOLUTION [108068]
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$34.28 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Senior |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.09
|
|
|
IBUPROFEN 800 MG/8 ML (100 MG/ML) INTRAVENOUS SOLUTION [108068]
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$3.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$3.10
|
| Rate for Payer: Networks By Design Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$3.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.27
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0904585561
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| 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 |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| 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 |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0904585560
|
| 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 |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 5965136201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 6787732101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0904585560
|
| 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: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| 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
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6068746801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0904585561
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6068746811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 5965136201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6438080706
|
| 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 |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 6068746801
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 6787732101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Senior |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6438080706
|
| 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 |
$0.10
|
| 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 |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| 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 |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.08
|
| 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 |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
IBUPROFEN 800 MG TABLET [3845]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 6068746811
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
OP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Multiplan Commercial |
$218.99
|
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Senior |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.48
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.73
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4.09
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [76780]
|
Facility
|
IP
|
$273.74
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Adventist Health Commercial |
$54.75
|
| Rate for Payer: Blue Shield of California Commercial |
$138.79
|
| Rate for Payer: Blue Shield of California Commercial |
$210.51
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cigna of CA HMO |
$191.62
|
| Rate for Payer: Cigna of CA PPO |
$191.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.50
|
| Rate for Payer: EPIC Health Plan Senior |
$109.50
|
| Rate for Payer: Galaxy Health WC |
$232.68
|
| Rate for Payer: Global Benefits Group Commercial |
$164.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$218.99
|
| Rate for Payer: Networks By Design Commercial |
$136.87
|
| Rate for Payer: Prime Health Services Commercial |
$232.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.73
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.65
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Blue Shield of California Commercial |
$35.76
|
| Rate for Payer: Blue Shield of California Commercial |
$54.25
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna of CA HMO |
$49.38
|
| Rate for Payer: Cigna of CA PPO |
$49.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: EPIC Health Plan Senior |
$28.22
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$56.43
|
| Rate for Payer: Networks By Design Commercial |
$35.27
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$25.77
|
| Rate for Payer: United Healthcare HMO Rider |
$25.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [16156]
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$1,888.71 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,888.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.69
|
| Rate for Payer: Blue Shield of California Commercial |
$365.42
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna of CA HMO |
$49.38
|
| Rate for Payer: Cigna of CA PPO |
$49.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.22
|
| Rate for Payer: EPIC Health Plan Senior |
$193.48
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$288.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.69
|
| Rate for Payer: Multiplan Commercial |
$56.43
|
| Rate for Payer: Networks By Design Commercial |
$35.27
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.47
|
| Rate for Payer: United Healthcare All Other HMO |
$25.77
|
| Rate for Payer: United Healthcare HMO Rider |
$25.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$175.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.48
|
| Rate for Payer: Vantage Medical Group Senior |
$193.48
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
IP
|
$12.42
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California Commercial |
$9.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8.15
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California Commercial |
$6.56
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION [22144]
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$1,045.71 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,045.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,045.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,045.71
|
| Rate for Payer: Blue Shield of California Commercial |
$62.08
|
| Rate for Payer: Blue Shield of California Commercial |
$62.08
|
| Rate for Payer: Blue Shield of California Commercial |
$62.08
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA HMO |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$11.25
|
| Rate for Payer: Cigna of CA PPO |
$8.69
|
| Rate for Payer: Cigna of CA PPO |
$9.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$4.97
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$11.00
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Galaxy Health WC |
$10.56
|
| Rate for Payer: Global Benefits Group Commercial |
$7.76
|
| Rate for Payer: Global Benefits Group Commercial |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.69
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$9.94
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Networks By Design Commercial |
$6.21
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Commercial |
$10.56
|
| Rate for Payer: Prime Health Services Commercial |
$11.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4.54
|
| Rate for Payer: United Healthcare HMO Rider |
$4.44
|
| Rate for Payer: United Healthcare HMO Rider |
$5.74
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.00
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
OP
|
$62.45
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$53.08 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.84
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Cigna of CA HMO |
$43.72
|
| Rate for Payer: Cigna of CA PPO |
$43.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.98
|
| Rate for Payer: EPIC Health Plan Senior |
$24.98
|
| Rate for Payer: Galaxy Health WC |
$53.08
|
| Rate for Payer: Global Benefits Group Commercial |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.72
|
| Rate for Payer: Multiplan Commercial |
$49.96
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$53.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$22.81
|
| Rate for Payer: United Healthcare HMO Rider |
$22.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.08
|
| Rate for Payer: Vantage Medical Group Senior |
$53.08
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [211698]
|
Facility
|
IP
|
$62.45
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$53.08 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$31.66
|
| Rate for Payer: Blue Shield of California Commercial |
$48.02
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Cigna of CA HMO |
$43.72
|
| Rate for Payer: Cigna of CA PPO |
$43.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.98
|
| Rate for Payer: EPIC Health Plan Senior |
$24.98
|
| Rate for Payer: Galaxy Health WC |
$53.08
|
| Rate for Payer: Global Benefits Group Commercial |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$49.96
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$53.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Other HMO |
$22.81
|
| Rate for Payer: United Healthcare HMO Rider |
$22.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.45
|
|
