|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 6787745430
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 6516263003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 5026845011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 5026845012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 5026845011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| 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 Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
|
OP
|
$35.31
|
|
|
Service Code
|
NDC 5045829001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$30.01 |
| Rate for Payer: Adventist Health Commercial |
$7.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.66
|
| Rate for Payer: Cash Price |
$15.89
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$24.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.12
|
| Rate for Payer: EPIC Health Plan Senior |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$30.01
|
| Rate for Payer: Global Benefits Group Commercial |
$21.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$28.25
|
| Rate for Payer: Networks By Design Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Commercial |
$30.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.66
|
| Rate for Payer: United Healthcare All Other HMO |
$17.66
|
| Rate for Payer: United Healthcare HMO Rider |
$17.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.01
|
| Rate for Payer: Vantage Medical Group Senior |
$30.01
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 6516208774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Senior |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 3172200631
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.28
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 6516208774
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna of CA HMO |
$1.65
|
| Rate for Payer: Cigna of CA PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Senior |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$1.88
|
| Rate for Payer: Networks By Design Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2.00
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 3172200631
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Senior |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
IVABRADINE 2.5 MG PARTIAL TABLET [4082315]
|
Facility
|
OP
|
$6.26
|
|
|
Service Code
|
NDC 9994082315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$5.01
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.13
|
| Rate for Payer: United Healthcare All Other HMO |
$3.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
IVABRADINE 2.5 MG PARTIAL TABLET [4082315]
|
Facility
|
IP
|
$6.26
|
|
|
Service Code
|
NDC 9994082315
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$4.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$5.01
|
| Rate for Payer: Networks By Design Commercial |
$4.07
|
| Rate for Payer: Prime Health Services Commercial |
$5.32
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$12.65
|
|
|
Service Code
|
NDC 6068786211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$8.86
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.06
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$10.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$10.75
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 6233267960
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 5074236260
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$12.65
|
|
|
Service Code
|
NDC 6068786221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.12
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$8.86
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.06
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$10.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$10.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.33
|
| Rate for Payer: United Healthcare All Other HMO |
$6.33
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10.75
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 6233267960
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 5074236260
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
IP
|
$12.65
|
|
|
Service Code
|
NDC 6068786221
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California Commercial |
$9.73
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$8.86
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.06
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$10.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$10.75
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
|
OP
|
$12.65
|
|
|
Service Code
|
NDC 6068786211
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.75 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.12
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cigna of CA HMO |
$8.86
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.06
|
| Rate for Payer: EPIC Health Plan Senior |
$5.06
|
| Rate for Payer: Galaxy Health WC |
$10.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.22
|
| Rate for Payer: Prime Health Services Commercial |
$10.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.33
|
| Rate for Payer: United Healthcare All Other HMO |
$6.33
|
| Rate for Payer: United Healthcare HMO Rider |
$6.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10.75
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
|
OP
|
$12.52
|
|
|
Service Code
|
NDC 5551381060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.03
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$8.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.01
|
| Rate for Payer: EPIC Health Plan Senior |
$5.01
|
| Rate for Payer: Galaxy Health WC |
$10.64
|
| Rate for Payer: Global Benefits Group Commercial |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$8.14
|
| Rate for Payer: Prime Health Services Commercial |
$10.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.26
|
| Rate for Payer: United Healthcare All Other HMO |
$6.26
|
| Rate for Payer: United Healthcare HMO Rider |
$6.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.64
|
| Rate for Payer: Vantage Medical Group Senior |
$10.64
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
|
IP
|
$12.52
|
|
|
Service Code
|
NDC 5551381060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$10.64 |
| Rate for Payer: Adventist Health Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9.63
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cigna of CA HMO |
$8.76
|
| Rate for Payer: Cigna of CA PPO |
$8.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.01
|
| Rate for Payer: EPIC Health Plan Senior |
$5.01
|
| Rate for Payer: Galaxy Health WC |
$10.64
|
| Rate for Payer: Global Benefits Group Commercial |
$7.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$8.14
|
| Rate for Payer: Prime Health Services Commercial |
$10.64
|
|
|
IVERMECTIN 3 MG TABLET [25820]
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 4279980601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$3.48
|
| Rate for Payer: Cigna of CA PPO |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1.99
|
| Rate for Payer: Galaxy Health WC |
$4.22
|
| Rate for Payer: Global Benefits Group Commercial |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$4.22
|
|
|
IVERMECTIN 3 MG TABLET [25820]
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 4279980601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Adventist Health Commercial |
$0.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.19
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna of CA HMO |
$3.48
|
| Rate for Payer: Cigna of CA PPO |
$3.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1.99
|
| Rate for Payer: Galaxy Health WC |
$4.22
|
| Rate for Payer: Global Benefits Group Commercial |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$3.23
|
| Rate for Payer: Prime Health Services Commercial |
$4.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2.48
|
| Rate for Payer: United Healthcare HMO Rider |
$2.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.22
|
|
|
IXABEPILONE 45 MG INTRAVENOUS SOLUTION [88653]
|
Facility
|
IP
|
$7,252.42
|
|
|
Service Code
|
HCPCS J9207
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,450.48 |
| Max. Negotiated Rate |
$6,164.56 |
| Rate for Payer: Adventist Health Commercial |
$1,450.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,676.98
|
| Rate for Payer: Blue Shield of California Commercial |
$5,577.11
|
| Rate for Payer: Cash Price |
$3,263.59
|
| Rate for Payer: Cigna of CA HMO |
$5,076.69
|
| Rate for Payer: Cigna of CA PPO |
$5,076.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,076.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.97
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.97
|
| Rate for Payer: Galaxy Health WC |
$6,164.56
|
| Rate for Payer: Global Benefits Group Commercial |
$4,351.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,605.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,278.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.58
|
| Rate for Payer: Multiplan Commercial |
$5,801.94
|
| Rate for Payer: Networks By Design Commercial |
$3,626.21
|
| Rate for Payer: Prime Health Services Commercial |
$6,164.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,721.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2,649.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,592.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,375.17
|
|
