|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
OP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.09
|
| Rate for Payer: Cigna of CA PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Media |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
OP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
IP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$21.83
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO |
$29.84
|
| Rate for Payer: Cigna of CA PPO |
$29.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$36.24
|
| Rate for Payer: Global Benefits Group Commercial |
$25.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$34.10
|
| Rate for Payer: Networks By Design Commercial |
$27.71
|
| Rate for Payer: Prime Health Services Commercial |
$36.24
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
OP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: BCBS Transplant Transplant |
$25.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.42
|
| Rate for Payer: Blue Shield of California EPN |
$24.90
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO |
$29.84
|
| Rate for Payer: Cigna of CA PPO |
$29.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.24
|
| Rate for Payer: Dignity Health Media |
$36.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$36.24
|
| Rate for Payer: Global Benefits Group Commercial |
$25.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$31.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.23
|
| Rate for Payer: Multiplan Commercial |
$34.10
|
| Rate for Payer: Networks By Design Commercial |
$27.71
|
| Rate for Payer: Prime Health Services Commercial |
$36.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$25.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.32
|
| Rate for Payer: United Healthcare All Other HMO |
$21.32
|
| Rate for Payer: United Healthcare HMO Rider |
$21.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.24
|
| Rate for Payer: Vantage Medical Group Senior |
$36.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
IP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Media |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$0.72
|
| Rate for Payer: United Healthcare HMO Rider |
$0.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
IP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
OP
|
$1.46
|
|
|
Service Code
|
NDC 24208-398-30
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.87
|
| Rate for Payer: BCBS Transplant Transplant |
$0.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
| Rate for Payer: Dignity Health Media |
$1.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$0.95
|
| Rate for Payer: Prime Health Services Commercial |
$1.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
IP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
OP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.72
|
| Rate for Payer: BCBS Transplant Transplant |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.45
|
| Rate for Payer: Dignity Health Media |
$2.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.45
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
OP
|
$2.92
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.74
|
| Rate for Payer: BCBS Transplant Transplant |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Media |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.17
|
| Rate for Payer: Galaxy Health WC |
$2.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$1.90
|
| Rate for Payer: Prime Health Services Commercial |
$2.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.47
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO |
$2.02
|
| Rate for Payer: Cigna of CA PPO |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.45
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: BCBS Transplant Transplant |
$0.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Media |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
IP
|
$9.91
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Blue Shield of California Commercial |
$7.06
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Blue Shield of California EPN |
$5.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$5.05
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$5.05
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
OP
|
$9.91
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.97
|
| 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: BCBS Transplant Transplant |
$4.90
|
| Rate for Payer: BCBS Transplant Transplant |
$4.33
|
| Rate for Payer: BCBS Transplant Transplant |
$2.59
|
| Rate for Payer: BCBS Transplant Transplant |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cigna of CA HMO |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$5.05
|
| Rate for Payer: Cigna of CA PPO |
$6.94
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Media |
$8.42
|
| Rate for Payer: Dignity Health Media |
$3.67
|
| Rate for Payer: Dignity Health Media |
$6.13
|
| Rate for Payer: Dignity Health Media |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$6.94
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$6.53
|
| Rate for Payer: Networks By Design Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.08
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$6.94
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.08
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$6.13
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
OP
|
$10.30
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.01
|
| 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: BCBS Transplant Transplant |
$7.78
|
| Rate for Payer: BCBS Transplant Transplant |
$6.18
|
| Rate for Payer: BCBS Transplant Transplant |
$9.95
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: BCBS Transplant Transplant |
$5.76
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$5.14
|
| Rate for Payer: BCBS Transplant Transplant |
$5.23
|
| Rate for Payer: BCBS Transplant Transplant |
$5.46
|
| Rate for Payer: BCBS Transplant Transplant |
$5.47
|
| Rate for Payer: Blue Shield of California Commercial |
$12.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| 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 |
$6.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$9.55
|
| 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 |
$3.92
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$3.92
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| 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 |
$7.21
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$7.21
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| 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 |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$11.61
|
| Rate for Payer: Cigna of CA PPO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| 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 |
$7.28
|
| 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 |
$8.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Media |
$7.41
|
| Rate for Payer: Dignity Health Media |
$7.74
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$7.28
|
| Rate for Payer: Dignity Health Media |
$8.16
|
| Rate for Payer: Dignity Health Media |
$7.74
|
| Rate for Payer: Dignity Health Media |
$11.02
|
| Rate for Payer: Dignity Health Media |
$14.09
|
| Rate for Payer: Dignity Health Media |
$4.59
|
| Rate for Payer: Dignity Health Media |
$8.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| 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 |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| 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 |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| 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 |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| 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 |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| 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 |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| 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 |
$5.46
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| 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 Commercial/Self Funded |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.08
|
| 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: 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 |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| 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 |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| Rate for Payer: Networks By Design Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$8.29
|
| 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 |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$5.15
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| 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 |
$11.02
|
| Rate for Payer: Prime Health Services Commercial |
$14.09
|
| 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 |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| 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 |
$7.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.18
|
| 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 |
$9.95
|
| 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 |
$6.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO |
$8.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO |
$5.15
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$4.28
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.56
|
| 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 |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.56
|
| 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 |
$7.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| 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 |
$8.76
|
| Rate for Payer: Vantage Medical Group Senior |
$14.09
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
IP
|
$5.40
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.48
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| 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 |
$5.98
|
| 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 |
$6.64
|
| Rate for Payer: Blue Shield of California EPN |
$4.38
|
| 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 |
$4.92
|
| Rate for Payer: Blue Shield of California EPN |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$4.46
|
| Rate for Payer: Blue Shield of California EPN |
$4.66
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA HMO |
$7.21
|
| 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 |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$5.99
|
| Rate for Payer: Cigna of CA HMO |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$6.38
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.10
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$6.38
|
| Rate for Payer: Cigna of CA PPO |
$11.61
|
| Rate for Payer: Cigna of CA PPO |
$7.21
|
| Rate for Payer: Cigna of CA PPO |
$5.99
|
| Rate for Payer: Cigna of CA PPO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| 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 |
$3.84
|
| 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 |
$6.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.49
|
| Rate for Payer: Galaxy Health WC |
$14.09
|
| Rate for Payer: Galaxy Health WC |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$6.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.06
|
| 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 |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| 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 |
$3.92
|
| 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: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| 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 |
$3.98
|
| 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: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$13.26
|
| Rate for Payer: Multiplan Commercial |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$6.98
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$6.85
|
| 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 |
$4.55
|
| Rate for Payer: Networks By Design Commercial |
$8.29
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$6.48
|
| 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 |
$7.28
|
| 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 |
$14.09
|
| 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 |
$7.41
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$6.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.90
|
| Rate for Payer: BCBS Transplant 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 Transplant 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$68.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.27
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$242.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$101.71
|
| Rate for Payer: IEHP Medi-Cal |
$100.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$100.47
|
| Rate for Payer: 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| 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
|
|
