|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
IP
|
$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: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: 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
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 51079-083-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: Blue Distinction Transplant |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: Dignity Health Media |
$1.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 0555-0071-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
NDC 51079-083-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 0555-0071-02
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 0555-0071-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 0555-0071-02
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Distinction Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
1715021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
1715021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: Blue Distinction Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: Dignity Health Media |
$0.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-42
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.02
|
| Rate for Payer: Blue Distinction Transplant |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.62
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$21.50
|
| Rate for Payer: Cigna of CA PPO |
$24.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Media |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-42
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Blue Shield of California Commercial |
$23.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.20
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.31
|
| Rate for Payer: Blue Distinction Transplant |
$24.48
|
| Rate for Payer: Blue Shield of California Commercial |
$30.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.83
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cigna of CA HMO |
$26.11
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.68
|
| Rate for Payer: Dignity Health Media |
$34.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$32.64
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO |
$20.40
|
| Rate for Payer: United Healthcare HMO Rider |
$20.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.68
|
| Rate for Payer: Vantage Medical Group Senior |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Blue Shield of California Commercial |
$29.05
|
| Rate for Payer: Blue Shield of California EPN |
$20.89
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$32.64
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-31
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Blue Shield of California Commercial |
$23.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.20
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.60
|
| Rate for Payer: Blue Distinction Transplant |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.38
|
| Rate for Payer: Blue Shield of California EPN |
$28.03
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Media |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-31
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.02
|
| Rate for Payer: Blue Distinction Transplant |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.62
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$21.50
|
| Rate for Payer: Cigna of CA PPO |
$24.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Media |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.06
|
| Rate for Payer: Multiplan Commercial |
$26.88
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.31
|
| Rate for Payer: Blue Distinction Transplant |
$24.48
|
| Rate for Payer: Blue Shield of California Commercial |
$30.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.83
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cigna of CA HMO |
$26.11
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.68
|
| Rate for Payer: Dignity Health Media |
$34.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$32.64
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO |
$20.40
|
| Rate for Payer: United Healthcare HMO Rider |
$20.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.68
|
| Rate for Payer: Vantage Medical Group Senior |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Blue Shield of California Commercial |
$34.18
|
| Rate for Payer: Blue Shield of California EPN |
$24.58
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$34.68 |
| Rate for Payer: Blue Shield of California Commercial |
$29.05
|
| Rate for Payer: Blue Shield of California EPN |
$20.89
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$32.64
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.60
|
| Rate for Payer: Blue Distinction Transplant |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.38
|
| Rate for Payer: Blue Shield of California EPN |
$28.03
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Media |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Blue Shield of California Commercial |
$34.18
|
| Rate for Payer: Blue Shield of California EPN |
$24.58
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 52536-006-09
|
| Hospital Charge Code |
1711911
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Blue Shield of California Commercial |
$2.37
|
| Rate for Payer: Blue Shield of California EPN |
$1.70
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna of CA HMO |
$2.33
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.83
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
OP
|
$3.33
|
|
|
Service Code
|
NDC 52536-006-09
|
| Hospital Charge Code |
1711911
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.98
|
| Rate for Payer: Blue Distinction Transplant |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna of CA HMO |
$2.33
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.83
|
| Rate for Payer: Dignity Health Media |
$2.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$2.66
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$2.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO |
$1.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2.83
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
IP
|
$5.21
|
|
|
Service Code
|
NDC 24338-010-09
|
| Hospital Charge Code |
1711911
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Blue Shield of California Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
OP
|
$5.21
|
|
|
Service Code
|
NDC 24338-010-09
|
| Hospital Charge Code |
1711911
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: Blue Distinction Transplant |
$3.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.43
|
| Rate for Payer: Dignity Health Media |
$4.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: Vantage Medical Group Senior |
$4.43
|
|
