|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION [108138]
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG108138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: Blue Distinction Transplant |
$5.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Media |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION [108138]
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG108138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California EPN |
$4.66
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
|
IP
|
$16.58
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6.21
|
| Rate for Payer: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California EPN |
$6.64
|
| Rate for Payer: Blue Shield of California EPN |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA HMO |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$7.21
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$7.21
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$11.61
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$14.09
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$8.76
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$6.18
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.29
|
| Rate for Payer: Networks By Design Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$6.48
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$5.15
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Prime Health Services Commercial |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$14.09
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.23
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.78
|
| Rate for Payer: United Healthcare HMO Rider |
$3.09
|
| Rate for Payer: United Healthcare HMO Rider |
$1.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.28
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare HMO Rider |
$5.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
|
OP
|
$8.56
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.05 |
| 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: 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: 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 |
$14.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.28
|
| 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: 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: 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 |
$3.24
|
| Rate for Payer: Blue Distinction Transplant |
$6.18
|
| Rate for Payer: Blue Distinction Transplant |
$7.78
|
| Rate for Payer: Blue Distinction Transplant |
$5.76
|
| Rate for Payer: Blue Distinction Transplant |
$5.47
|
| Rate for Payer: Blue Distinction Transplant |
$5.46
|
| Rate for Payer: Blue Distinction Transplant |
$9.95
|
| Rate for Payer: Blue Distinction Transplant |
$5.23
|
| Rate for Payer: Blue Distinction Transplant |
$5.14
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California Commercial |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$9.55
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$12.22
|
| 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: 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: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA HMO |
$7.21
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$11.61
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$7.21
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.28
|
| Rate for Payer: Dignity Health Media |
$14.09
|
| Rate for Payer: Dignity Health Media |
$7.28
|
| Rate for Payer: Dignity Health Media |
$11.02
|
| Rate for Payer: Dignity Health Media |
$7.74
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$8.16
|
| Rate for Payer: Dignity Health Media |
$7.41
|
| Rate for Payer: Dignity Health Media |
$7.74
|
| Rate for Payer: Dignity Health Media |
$8.76
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$14.09
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Global Benefits Group Commercial |
$6.18
|
| Rate for Payer: Global Benefits Group Commercial |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.83
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| 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: 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: 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 |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$8.29
|
| Rate for Payer: Networks By Design Commercial |
$5.15
|
| Rate for Payer: Networks By Design Commercial |
$6.48
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Prime Health Services Commercial |
$14.09
|
| Rate for Payer: Prime Health Services Commercial |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$8.29
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$5.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| Rate for Payer: United Healthcare HMO Rider |
$8.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$4.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.09
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$14.09
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$8.76
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
OP
|
$7.07
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG94341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: Blue Distinction Transplant |
$4.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$4.95
|
| Rate for Payer: Cigna of CA PPO |
$4.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.01
|
| Rate for Payer: Dignity Health Media |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.83
|
| Rate for Payer: Galaxy Health WC |
$6.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$3.54
|
| Rate for Payer: Prime Health Services Commercial |
$6.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO |
$3.54
|
| Rate for Payer: United Healthcare HMO Rider |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
IP
|
$7.07
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG94341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.62
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO |
$4.95
|
| Rate for Payer: Cigna of CA PPO |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.83
|
| Rate for Payer: Galaxy Health WC |
$6.01
|
| Rate for Payer: Global Benefits Group Commercial |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$3.54
|
| Rate for Payer: Prime Health Services Commercial |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.33
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
OP
|
$323.88
|
|
|
Service Code
|
CPT J9205
|
| Hospital Charge Code |
NDG211718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.27
|
| Rate for Payer: Blue Distinction Transplant |
$194.33
|
| Rate for Payer: Blue Shield of California Commercial |
$238.70
|
| Rate for Payer: Blue Shield of California EPN |
$66.03
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$226.72
|
| Rate for Payer: Cigna of CA PPO |
$226.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.03
|
| Rate for Payer: Dignity Health Media |
$62.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.02
|
| Rate for Payer: Galaxy Health WC |
$275.30
|
| Rate for Payer: Global Benefits Group Commercial |
$194.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$242.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$101.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$100.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.11
|
| Rate for Payer: Multiplan Commercial |
$259.10
|
| Rate for Payer: Networks By Design Commercial |
$161.94
|
| Rate for Payer: Prime Health Services Commercial |
$275.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.94
|
| Rate for Payer: United Healthcare All Other HMO |
$161.94
|
| Rate for Payer: United Healthcare HMO Rider |
$161.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.22
|
| Rate for Payer: Vantage Medical Group Senior |
$62.02
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
IP
|
$323.88
|
|
|
Service Code
|
CPT J9205
|
| Hospital Charge Code |
NDG211718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Blue Shield of California Commercial |
$230.60
|
| Rate for Payer: Blue Shield of California EPN |
$165.83
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$226.72
|
| Rate for Payer: Cigna of CA PPO |
$226.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$129.55
|
| Rate for Payer: Galaxy Health WC |
$275.30
|
| Rate for Payer: Global Benefits Group Commercial |
$194.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.73
|
| Rate for Payer: Multiplan Commercial |
$259.10
|
| Rate for Payer: Networks By Design Commercial |
$161.94
|
| Rate for Payer: Prime Health Services Commercial |
$275.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.30
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.88
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
1711916
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
1711916
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
OP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-10
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Distinction Transplant |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.85
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Media |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.14
|
| Rate for Payer: United Healthcare All Other HMO |
$10.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
OP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-01
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Distinction Transplant |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.85
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Media |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.14
|
| Rate for Payer: United Healthcare All Other HMO |
$10.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
IP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-01
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7.48
|
| Rate for Payer: United Healthcare HMO Rider |
$7.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
IP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-10
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7.48
|
| Rate for Payer: United Healthcare HMO Rider |
$7.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
|
OP
|
$13.86
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
1720948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Blue Distinction Transplant |
$8.32
|
| Rate for Payer: Blue Distinction Transplant |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA HMO |
$6.18
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$6.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.78
|
| Rate for Payer: Dignity Health Media |
$7.51
|
| Rate for Payer: Dignity Health Media |
$11.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.53
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Galaxy Health WC |
$7.51
|
| Rate for Payer: Global Benefits Group Commercial |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Networks By Design Commercial |
$4.42
|
| Rate for Payer: Prime Health Services Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4.42
|
| Rate for Payer: United Healthcare All Other HMO |
$6.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.42
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.51
|
| Rate for Payer: Vantage Medical Group Senior |
$7.51
|
| Rate for Payer: Vantage Medical Group Senior |
$11.78
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
|
IP
|
$13.86
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
1720948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Blue Shield of California Commercial |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.52
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA HMO |
$6.18
|
| Rate for Payer: Cigna of CA PPO |
$6.18
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.53
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Galaxy Health WC |
$7.51
|
| Rate for Payer: Global Benefits Group Commercial |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$7.06
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Networks By Design Commercial |
$4.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Prime Health Services Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.91
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
Facility
|
OP
|
$11.52
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
NDG187493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Blue Distinction Transplant |
$6.91
|
| Rate for Payer: Blue Distinction Transplant |
$8.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: Dignity Health Media |
$11.78
|
| Rate for Payer: Dignity Health Media |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$5.76
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare HMO Rider |
$5.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: Vantage Medical Group Senior |
$11.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9.79
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
Facility
|
IP
|
$11.52
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
NDG187493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Blue Shield of California Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare HMO Rider |
$4.16
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.57
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
OP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0654-01
|
| Hospital Charge Code |
NDG227445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.73
|
| Rate for Payer: Blue Distinction Transplant |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$133.26
|
| Rate for Payer: Blue Shield of California EPN |
$105.59
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.69
|
| Rate for Payer: Dignity Health Media |
$153.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$135.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.40
|
| Rate for Payer: United Healthcare All Other HMO |
$90.40
|
| Rate for Payer: United Healthcare HMO Rider |
$90.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.69
|
| Rate for Payer: Vantage Medical Group Senior |
$153.69
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0656-01
|
| Hospital Charge Code |
NDG227445A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Blue Shield of California Commercial |
$128.74
|
| Rate for Payer: Blue Shield of California EPN |
$92.57
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.27
|
| Rate for Payer: United Healthcare All Other HMO |
$66.68
|
| Rate for Payer: United Healthcare HMO Rider |
$65.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.67
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
OP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0656-01
|
| Hospital Charge Code |
NDG227445A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.73
|
| Rate for Payer: Blue Distinction Transplant |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$133.26
|
| Rate for Payer: Blue Shield of California EPN |
$105.59
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.69
|
| Rate for Payer: Dignity Health Media |
$153.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$135.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.40
|
| Rate for Payer: United Healthcare All Other HMO |
$90.40
|
| Rate for Payer: United Healthcare HMO Rider |
$90.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.69
|
| Rate for Payer: Vantage Medical Group Senior |
$153.69
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0654-01
|
| Hospital Charge Code |
NDG227445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Blue Shield of California Commercial |
$128.74
|
| Rate for Payer: Blue Shield of California EPN |
$92.57
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.27
|
| Rate for Payer: United Healthcare All Other HMO |
$66.68
|
| Rate for Payer: United Healthcare HMO Rider |
$65.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.67
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
IP
|
$128.43
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
ERX209331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$109.17 |
| Rate for Payer: Blue Shield of California Commercial |
$91.44
|
| Rate for Payer: Blue Shield of California EPN |
$65.76
|
| Rate for Payer: Cash Price |
$57.79
|
| Rate for Payer: Cigna of CA HMO |
$89.90
|
| Rate for Payer: Cigna of CA PPO |
$89.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.37
|
| Rate for Payer: Galaxy Health WC |
$109.17
|
| Rate for Payer: Global Benefits Group Commercial |
$77.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$102.74
|
| Rate for Payer: Networks By Design Commercial |
$83.48
|
| Rate for Payer: Prime Health Services Commercial |
$109.17
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
OP
|
$128.43
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
ERX209331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$109.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.52
|
| Rate for Payer: Blue Distinction Transplant |
$77.06
|
| Rate for Payer: Blue Shield of California Commercial |
$94.65
|
| Rate for Payer: Blue Shield of California EPN |
$75.00
|
| Rate for Payer: Cash Price |
$57.79
|
| Rate for Payer: Cigna of CA HMO |
$89.90
|
| Rate for Payer: Cigna of CA PPO |
$89.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.17
|
| Rate for Payer: Dignity Health Media |
$109.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.37
|
| Rate for Payer: Galaxy Health WC |
$109.17
|
| Rate for Payer: Global Benefits Group Commercial |
$77.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$102.74
|
| Rate for Payer: Networks By Design Commercial |
$83.48
|
| Rate for Payer: Prime Health Services Commercial |
$109.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.22
|
| Rate for Payer: United Healthcare All Other HMO |
$64.22
|
| Rate for Payer: United Healthcare HMO Rider |
$64.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.17
|
| Rate for Payer: Vantage Medical Group Senior |
$109.17
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| Hospital Charge Code |
1710461
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| 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 |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
