|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
1711916
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
IP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-10
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
OP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-10
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: BCBS Transplant Transplant |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.85
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Media |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.14
|
| Rate for Payer: United Healthcare All Other HMO |
$10.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
IP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-01
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Blue Shield of California Commercial |
$14.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
OP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-01
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: BCBS Transplant Transplant |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.85
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO |
$14.20
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Media |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.12
|
| Rate for Payer: Galaxy Health WC |
$17.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$10.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.14
|
| Rate for Payer: United Healthcare All Other HMO |
$10.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
OP
|
$8.83
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
1720948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: BCBS Transplant Transplant |
$8.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA HMO |
$6.18
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$6.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.78
|
| Rate for Payer: Dignity Health Media |
$7.51
|
| Rate for Payer: Dignity Health Media |
$11.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.53
|
| Rate for Payer: Galaxy Health WC |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$7.06
|
| Rate for Payer: Networks By Design Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$4.42
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.51
|
| Rate for Payer: Vantage Medical Group Senior |
$11.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7.51
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
IP
|
$8.83
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
1720948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$7.51 |
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California Commercial |
$9.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.52
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cigna of CA HMO |
$6.18
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$6.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: Galaxy Health WC |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Networks By Design Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Prime Health Services Commercial |
$7.51
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
Facility
IP
|
$11.52
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
NDG187493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Blue Shield of California Commercial |
$8.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.90
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
Facility
OP
|
$11.52
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
NDG187493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: BCBS Transplant Transplant |
$8.32
|
| Rate for Payer: BCBS Transplant Transplant |
$6.91
|
| Rate for Payer: Blue Shield of California Commercial |
$8.49
|
| Rate for Payer: Blue Shield of California Commercial |
$10.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Cigna of CA PPO |
$8.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.78
|
| Rate for Payer: Dignity Health Media |
$11.78
|
| Rate for Payer: Dignity Health Media |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.61
|
| Rate for Payer: Galaxy Health WC |
$9.79
|
| Rate for Payer: Galaxy Health WC |
$11.78
|
| Rate for Payer: Global Benefits Group Commercial |
$6.91
|
| Rate for Payer: Global Benefits Group Commercial |
$8.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Prime Health Services Commercial |
$9.79
|
| Rate for Payer: Prime Health Services Commercial |
$11.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$6.93
|
| Rate for Payer: United Healthcare All Other HMO |
$5.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5.76
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.78
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
OP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0654-01
|
| Hospital Charge Code |
NDG227445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.73
|
| Rate for Payer: BCBS Transplant Transplant |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$133.26
|
| Rate for Payer: Blue Shield of California EPN |
$105.59
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.69
|
| Rate for Payer: Dignity Health Media |
$153.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.40
|
| Rate for Payer: United Healthcare All Other HMO |
$90.40
|
| Rate for Payer: United Healthcare HMO Rider |
$90.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.69
|
| Rate for Payer: Vantage Medical Group Senior |
$153.69
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
OP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0656-01
|
| Hospital Charge Code |
NDG227445A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.73
|
| Rate for Payer: BCBS Transplant Transplant |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$133.26
|
| Rate for Payer: Blue Shield of California EPN |
$105.59
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.69
|
| Rate for Payer: Dignity Health Media |
$153.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.40
|
| Rate for Payer: United Healthcare All Other HMO |
$90.40
|
| Rate for Payer: United Healthcare HMO Rider |
$90.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.69
|
| Rate for Payer: Vantage Medical Group Senior |
$153.69
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
IP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0654-01
|
| Hospital Charge Code |
NDG227445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Blue Shield of California Commercial |
$128.74
|
| Rate for Payer: Blue Shield of California EPN |
$92.57
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
IP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0656-01
|
| Hospital Charge Code |
NDG227445A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: Blue Shield of California Commercial |
$128.74
|
| Rate for Payer: Blue Shield of California EPN |
$92.57
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$144.65
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
OP
|
$128.43
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
ERX209331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$109.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.52
|
| Rate for Payer: BCBS Transplant Transplant |
$77.06
|
| Rate for Payer: Blue Shield of California Commercial |
$94.65
|
| Rate for Payer: Blue Shield of California EPN |
$75.00
|
| Rate for Payer: Cash Price |
$57.79
|
| Rate for Payer: Cigna of CA HMO |
$89.90
|
| Rate for Payer: Cigna of CA PPO |
$89.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.17
|
| Rate for Payer: Dignity Health Media |
$109.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.37
|
| Rate for Payer: Galaxy Health WC |
$109.17
|
| Rate for Payer: Global Benefits Group Commercial |
$77.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$102.74
|
| Rate for Payer: Networks By Design Commercial |
$83.48
|
| Rate for Payer: Prime Health Services Commercial |
$109.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$77.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.22
|
| Rate for Payer: United Healthcare All Other HMO |
$64.22
|
| Rate for Payer: United Healthcare HMO Rider |
$64.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.17
|
| Rate for Payer: Vantage Medical Group Senior |
$109.17
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
IP
|
$128.43
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
ERX209331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$109.17 |
| Rate for Payer: Blue Shield of California Commercial |
$91.44
|
| Rate for Payer: Blue Shield of California EPN |
$65.76
|
| Rate for Payer: Cash Price |
$57.79
|
| Rate for Payer: Cigna of CA HMO |
$89.90
|
| Rate for Payer: Cigna of CA PPO |
$89.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.37
|
| Rate for Payer: Galaxy Health WC |
$109.17
|
| Rate for Payer: Global Benefits Group Commercial |
$77.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$102.74
|
| Rate for Payer: Networks By Design Commercial |
$83.48
|
| Rate for Payer: Prime Health Services Commercial |
$109.17
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
OP
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| Hospital Charge Code |
1710461
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| 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 |
$0.08
|
| 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 |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: 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 |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
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
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
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
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: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| 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 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
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: AlphaCare Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.74
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.74
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.29
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| 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
|
|
|
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
|
|
