|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 76204-600-01
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [207748]
|
Facility
|
IP
|
$142.53
|
|
|
Service Code
|
NDC 0597-0024-02
|
| Hospital Charge Code |
NDG196679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$121.15 |
| Rate for Payer: Blue Shield of California Commercial |
$101.48
|
| Rate for Payer: Blue Shield of California EPN |
$72.98
|
| Rate for Payer: Cash Price |
$64.14
|
| Rate for Payer: Cigna of CA HMO |
$99.77
|
| Rate for Payer: Cigna of CA PPO |
$99.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.01
|
| Rate for Payer: Galaxy Health WC |
$121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$85.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$114.02
|
| Rate for Payer: Networks By Design Commercial |
$92.64
|
| Rate for Payer: Prime Health Services Commercial |
$121.15
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [207748]
|
Facility
|
OP
|
$142.53
|
|
|
Service Code
|
NDC 0597-0024-02
|
| Hospital Charge Code |
NDG196679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$121.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$93.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.92
|
| Rate for Payer: Blue Distinction Transplant |
$85.52
|
| Rate for Payer: Blue Shield of California Commercial |
$105.04
|
| Rate for Payer: Blue Shield of California EPN |
$83.24
|
| Rate for Payer: Cash Price |
$64.14
|
| Rate for Payer: Cigna of CA HMO |
$99.77
|
| Rate for Payer: Cigna of CA PPO |
$99.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.15
|
| Rate for Payer: Dignity Health Media |
$121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$57.01
|
| Rate for Payer: Galaxy Health WC |
$121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$85.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$106.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$114.02
|
| Rate for Payer: Networks By Design Commercial |
$92.64
|
| Rate for Payer: Prime Health Services Commercial |
$121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.26
|
| Rate for Payer: United Healthcare All Other HMO |
$71.26
|
| Rate for Payer: United Healthcare HMO Rider |
$71.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$121.15
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| 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: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: 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
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| 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 |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Distinction Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| 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 Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| 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 |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-83
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| 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: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: 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
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-83
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| 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 |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Distinction Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| 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 Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Blue Distinction Transplant |
$25.58
|
| Rate for Payer: Blue Shield of California Commercial |
$31.42
|
| Rate for Payer: Blue Shield of California EPN |
$24.90
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO |
$29.84
|
| Rate for Payer: Cigna of CA PPO |
$29.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.24
|
| Rate for Payer: Dignity Health Media |
$36.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$36.24
|
| Rate for Payer: Global Benefits Group Commercial |
$25.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$34.10
|
| Rate for Payer: Networks By Design Commercial |
$27.71
|
| Rate for Payer: Prime Health Services Commercial |
$36.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.32
|
| Rate for Payer: United Healthcare All Other HMO |
$21.32
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.24
|
| Rate for Payer: Vantage Medical Group Senior |
$36.24
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
IP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$21.83
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO |
$29.84
|
| Rate for Payer: Cigna of CA PPO |
$29.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$36.24
|
| Rate for Payer: Global Benefits Group Commercial |
$25.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$34.10
|
| Rate for Payer: Networks By Design Commercial |
$27.71
|
| Rate for Payer: Prime Health Services Commercial |
$36.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: Blue Distinction Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.87
|
| Rate for Payer: Blue Distinction Transplant |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
| Rate for Payer: Dignity Health Media |
$1.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: Blue Distinction Transplant |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.45
|
| Rate for Payer: Dignity Health Media |
$2.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.45
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: Blue Distinction Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.63
|
| Rate for Payer: United Healthcare All Other HMO |
$3.01
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$1.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: Blue Distinction Transplant |
$4.33
|
| Rate for Payer: Blue Distinction Transplant |
$2.59
|
| Rate for Payer: Blue Distinction Transplant |
$5.95
|
| Rate for Payer: Blue Distinction Transplant |
$4.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.30
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Cigna of CA PPO |
$5.05
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Media |
$8.42
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Media |
$6.13
|
| Rate for Payer: Dignity Health Media |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.13
|
|
