|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION [121793]
|
Facility
|
IP
|
$15.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.03 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California Commercial |
$12.50
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Central Health Plan Commercial |
$12.47
|
| Rate for Payer: Cigna of CA HMO |
$10.91
|
| Rate for Payer: Cigna of CA PPO |
$10.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Senior |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$13.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$7.79
|
| Rate for Payer: Prime Health Services Commercial |
$13.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5.70
|
| Rate for Payer: United Healthcare HMO Rider |
$5.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.11
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
OP
|
$229.47
|
|
|
Service Code
|
HCPCS J9227
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$206.52 |
| Rate for Payer: Adventist Health Commercial |
$45.89
|
| Rate for Payer: Adventist Health Commercial |
$45.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$88.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$88.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.56
|
| Rate for Payer: Blue Shield of California Commercial |
$104.48
|
| Rate for Payer: Blue Shield of California Commercial |
$104.48
|
| Rate for Payer: Blue Shield of California EPN |
$94.98
|
| Rate for Payer: Blue Shield of California EPN |
$94.98
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Central Health Plan Commercial |
$183.58
|
| Rate for Payer: Central Health Plan Commercial |
$183.57
|
| Rate for Payer: Cigna of CA HMO |
$160.63
|
| Rate for Payer: Cigna of CA HMO |
$160.62
|
| Rate for Payer: Cigna of CA PPO |
$160.63
|
| Rate for Payer: Cigna of CA PPO |
$160.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.46
|
| Rate for Payer: EPIC Health Plan Senior |
$96.98
|
| Rate for Payer: EPIC Health Plan Senior |
$96.98
|
| Rate for Payer: Galaxy Health WC |
$195.04
|
| Rate for Payer: Galaxy Health WC |
$195.05
|
| Rate for Payer: Global Benefits Group Commercial |
$137.68
|
| Rate for Payer: Global Benefits Group Commercial |
$137.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.13
|
| Rate for Payer: Multiplan Commercial |
$172.09
|
| Rate for Payer: Multiplan Commercial |
$172.10
|
| Rate for Payer: Networks By Design Commercial |
$114.73
|
| Rate for Payer: Networks By Design Commercial |
$114.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$88.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$88.16
|
| Rate for Payer: Prime Health Services Commercial |
$195.04
|
| Rate for Payer: Prime Health Services Commercial |
$195.05
|
| Rate for Payer: Prime Health Services Medicare |
$93.45
|
| Rate for Payer: Prime Health Services Medicare |
$93.45
|
| Rate for Payer: Riverside University Health System MISP |
$96.98
|
| Rate for Payer: Riverside University Health System MISP |
$96.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.12
|
| Rate for Payer: United Healthcare All Other HMO |
$83.82
|
| Rate for Payer: United Healthcare All Other HMO |
$83.83
|
| Rate for Payer: United Healthcare HMO Rider |
$82.01
|
| Rate for Payer: United Healthcare HMO Rider |
$82.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$88.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$88.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.98
|
| Rate for Payer: Vantage Medical Group Senior |
$96.98
|
| Rate for Payer: Vantage Medical Group Senior |
$96.98
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
IP
|
$229.47
|
|
|
Service Code
|
HCPCS J9227
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$206.52 |
| Rate for Payer: Adventist Health Commercial |
$45.89
|
| Rate for Payer: Adventist Health Commercial |
$45.89
|
| Rate for Payer: Blue Shield of California Commercial |
$184.03
|
| Rate for Payer: Blue Shield of California Commercial |
$184.03
|
| Rate for Payer: Blue Shield of California EPN |
$115.65
|
| Rate for Payer: Blue Shield of California EPN |
$115.65
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Central Health Plan Commercial |
$183.58
|
| Rate for Payer: Central Health Plan Commercial |
$183.57
|
| Rate for Payer: Cigna of CA HMO |
$160.62
|
| Rate for Payer: Cigna of CA HMO |
$160.63
|
| Rate for Payer: Cigna of CA PPO |
$160.62
|
| Rate for Payer: Cigna of CA PPO |
$160.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.79
|
| Rate for Payer: EPIC Health Plan Senior |
$91.78
|
| Rate for Payer: EPIC Health Plan Senior |
$91.79
|
| Rate for Payer: Galaxy Health WC |
$195.05
|
| Rate for Payer: Galaxy Health WC |
$195.04
|
| Rate for Payer: Global Benefits Group Commercial |
$137.68
|
| Rate for Payer: Global Benefits Group Commercial |
$137.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.89
|
| Rate for Payer: Multiplan Commercial |
$172.09
|
| Rate for Payer: Multiplan Commercial |
$172.10
|
| Rate for Payer: Networks By Design Commercial |
$114.73
|
| Rate for Payer: Networks By Design Commercial |
$114.73
|
| Rate for Payer: Prime Health Services Commercial |
$195.05
|
| Rate for Payer: Prime Health Services Commercial |
$195.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.12
|
| Rate for Payer: United Healthcare All Other HMO |
$83.83
|
| Rate for Payer: United Healthcare All Other HMO |
$83.82
|
| Rate for Payer: United Healthcare HMO Rider |
$82.01
|
| Rate for Payer: United Healthcare HMO Rider |
$82.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.15
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
IP
|
$143.06
|
|
|
Service Code
|
NDC 0469052001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Adventist Health Commercial |
$28.61
|
| Rate for Payer: Blue Shield of California Commercial |
$114.73
|
| Rate for Payer: Blue Shield of California EPN |
$72.10
|
| Rate for Payer: Cash Price |
$64.38
|
| Rate for Payer: Central Health Plan Commercial |
$114.45
|
| Rate for Payer: Cigna of CA HMO |
$100.14
|
| Rate for Payer: Cigna of CA PPO |
$100.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.22
|
| Rate for Payer: EPIC Health Plan Senior |
$57.22
|
| Rate for Payer: Galaxy Health WC |
$121.60
|
| Rate for Payer: Global Benefits Group Commercial |
$85.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Multiplan Commercial |
$107.30
|
| Rate for Payer: Networks By Design Commercial |
$92.99
|
| Rate for Payer: Prime Health Services Commercial |
$121.60
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
OP
|
$143.06
|
|
|
Service Code
|
NDC 0469052001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Adventist Health Commercial |
$28.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.22
|
| Rate for Payer: Blue Shield of California Commercial |
$90.70
|
| Rate for Payer: Blue Shield of California EPN |
$57.08
|
| Rate for Payer: Cash Price |
$64.38
|
| Rate for Payer: Central Health Plan Commercial |
$114.45
|
| Rate for Payer: Cigna of CA HMO |
$100.14
|
| Rate for Payer: Cigna of CA PPO |
$100.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.22
|
| Rate for Payer: EPIC Health Plan Senior |
$57.22
|
| Rate for Payer: Galaxy Health WC |
$121.60
|
| Rate for Payer: Global Benefits Group Commercial |
$85.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.14
|
| Rate for Payer: Multiplan Commercial |
$107.30
|
| Rate for Payer: Networks By Design Commercial |
$92.99
|
| Rate for Payer: Prime Health Services Commercial |
$121.60
|
| Rate for Payer: Riverside University Health System MISP |
$57.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.53
|
| Rate for Payer: United Healthcare All Other HMO |
$71.53
|
| Rate for Payer: United Healthcare HMO Rider |
$71.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.60
|
| Rate for Payer: Vantage Medical Group Senior |
$121.60
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
OP
|
$143.06
|
|
|
Service Code
|
NDC 0469052002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Adventist Health Commercial |
$28.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.22
|
| Rate for Payer: Blue Shield of California Commercial |
$90.70
|
| Rate for Payer: Blue Shield of California EPN |
$57.08
|
| Rate for Payer: Cash Price |
$64.38
|
| Rate for Payer: Central Health Plan Commercial |
$114.45
|
| Rate for Payer: Cigna of CA HMO |
$100.14
|
| Rate for Payer: Cigna of CA PPO |
$100.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.22
|
| Rate for Payer: EPIC Health Plan Senior |
$57.22
|
| Rate for Payer: Galaxy Health WC |
$121.60
|
| Rate for Payer: Global Benefits Group Commercial |
$85.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.14
|
| Rate for Payer: Multiplan Commercial |
$107.30
|
| Rate for Payer: Networks By Design Commercial |
$92.99
|
| Rate for Payer: Prime Health Services Commercial |
$121.60
|
| Rate for Payer: Riverside University Health System MISP |
$57.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.53
|
| Rate for Payer: United Healthcare All Other HMO |
$71.53
|
| Rate for Payer: United Healthcare HMO Rider |
$71.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.60
|
| Rate for Payer: Vantage Medical Group Senior |
$121.60
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
IP
|
$143.06
|
|
|
Service Code
|
NDC 0469052002
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Adventist Health Commercial |
$28.61
|
| Rate for Payer: Blue Shield of California Commercial |
$114.73
|
| Rate for Payer: Blue Shield of California EPN |
$72.10
|
| Rate for Payer: Cash Price |
$64.38
|
| Rate for Payer: Central Health Plan Commercial |
$114.45
|
| Rate for Payer: Cigna of CA HMO |
$100.14
|
| Rate for Payer: Cigna of CA PPO |
$100.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.22
|
| Rate for Payer: EPIC Health Plan Senior |
$57.22
|
| Rate for Payer: Galaxy Health WC |
$121.60
|
| Rate for Payer: Global Benefits Group Commercial |
$85.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.61
|
| Rate for Payer: Multiplan Commercial |
$107.30
|
| Rate for Payer: Networks By Design Commercial |
$92.99
|
| Rate for Payer: Prime Health Services Commercial |
$121.60
|
|
|
ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION [209328]
|
Facility
|
OP
|
$487.45
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$438.70 |
| Rate for Payer: Adventist Health Commercial |
$97.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$219.35
|
| Rate for Payer: Cash Price |
$219.35
|
| Rate for Payer: Central Health Plan Commercial |
$389.96
|
| Rate for Payer: Cigna of CA HMO |
$341.21
|
| Rate for Payer: Cigna of CA PPO |
$341.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$414.33
|
| Rate for Payer: Global Benefits Group Commercial |
$292.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$365.59
|
| Rate for Payer: Networks By Design Commercial |
$243.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.03
|
| Rate for Payer: Prime Health Services Commercial |
$414.33
|
| Rate for Payer: Prime Health Services Medicare |
$1.09
|
| Rate for Payer: Riverside University Health System MISP |
$1.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.94
|
| Rate for Payer: United Healthcare All Other HMO |
$178.07
|
| Rate for Payer: United Healthcare HMO Rider |
$174.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION [209328]
|
Facility
|
IP
|
$487.45
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.49 |
| Max. Negotiated Rate |
$438.70 |
| Rate for Payer: Adventist Health Commercial |
$97.49
|
| Rate for Payer: Blue Shield of California Commercial |
$390.93
|
| Rate for Payer: Blue Shield of California EPN |
$245.67
|
| Rate for Payer: Cash Price |
$219.35
|
| Rate for Payer: Central Health Plan Commercial |
$389.96
|
| Rate for Payer: Cigna of CA HMO |
$341.21
|
| Rate for Payer: Cigna of CA PPO |
$341.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.98
|
| Rate for Payer: EPIC Health Plan Senior |
$194.98
|
| Rate for Payer: Galaxy Health WC |
$414.33
|
| Rate for Payer: Global Benefits Group Commercial |
$292.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.49
|
| Rate for Payer: Multiplan Commercial |
$365.59
|
| Rate for Payer: Networks By Design Commercial |
$243.72
|
| Rate for Payer: Prime Health Services Commercial |
$414.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.94
|
| Rate for Payer: United Healthcare All Other HMO |
$178.07
|
| Rate for Payer: United Healthcare HMO Rider |
$174.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.64
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE [239551]
|
Facility
|
OP
|
$57.35
|
|
|
Service Code
|
NDC 0469286035
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Adventist Health Commercial |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.36
|
| Rate for Payer: Blue Shield of California Commercial |
$36.36
|
| Rate for Payer: Blue Shield of California EPN |
$22.88
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Central Health Plan Commercial |
$45.88
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$40.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.94
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$48.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.15
|
| Rate for Payer: Multiplan Commercial |
$43.01
|
| Rate for Payer: Networks By Design Commercial |
$37.28
|
| Rate for Payer: Prime Health Services Commercial |
$48.75
|
| Rate for Payer: Riverside University Health System MISP |
$22.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.68
|
| Rate for Payer: United Healthcare All Other HMO |
$28.68
|
| Rate for Payer: United Healthcare HMO Rider |
$28.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.75
|
| Rate for Payer: Vantage Medical Group Senior |
$48.75
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE [239551]
|
Facility
|
IP
|
$57.35
|
|
|
Service Code
|
NDC 0469286035
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Adventist Health Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$45.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.90
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Central Health Plan Commercial |
$45.88
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$40.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.94
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$48.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$43.01
|
| Rate for Payer: Networks By Design Commercial |
$37.28
|
| Rate for Payer: Prime Health Services Commercial |
$48.75
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE [239551]
|
Facility
|
IP
|
$57.35
|
|
|
Service Code
|
NDC 0469286001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Adventist Health Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$45.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.90
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Central Health Plan Commercial |
$45.88
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$40.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.94
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$48.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$43.01
|
| Rate for Payer: Networks By Design Commercial |
$37.28
|
| Rate for Payer: Prime Health Services Commercial |
$48.75
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE [239551]
|
Facility
|
OP
|
$57.35
|
|
|
Service Code
|
NDC 0469286001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$51.62 |
| Rate for Payer: Adventist Health Commercial |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.36
|
| Rate for Payer: Blue Shield of California Commercial |
$36.36
|
| Rate for Payer: Blue Shield of California EPN |
$22.88
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Central Health Plan Commercial |
$45.88
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$40.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.94
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$48.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.15
|
| Rate for Payer: Multiplan Commercial |
$43.01
|
| Rate for Payer: Networks By Design Commercial |
$37.28
|
| Rate for Payer: Prime Health Services Commercial |
$48.75
|
| Rate for Payer: Riverside University Health System MISP |
$22.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.68
|
| Rate for Payer: United Healthcare All Other HMO |
$28.68
|
| Rate for Payer: United Healthcare HMO Rider |
$28.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.75
|
| Rate for Payer: Vantage Medical Group Senior |
$48.75
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$46,247.75
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$46,247.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,247.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,874.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,824.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,476.02
|
| Rate for Payer: EPIC Health Plan Senior |
$27,650.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,136.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,191.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,683.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,136.98
|
| Rate for Payer: Prime Health Services Medicare |
$26,645.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$72,564.11
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$72,564.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,564.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,873.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,624.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$64,230.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42,820.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,927.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,498.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52,163.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38,927.66
|
| Rate for Payer: Prime Health Services Medicare |
$41,263.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$36,946.61
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$36,946.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,946.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,866.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,413.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,433.77
|
| Rate for Payer: EPIC Health Plan Senior |
$22,289.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,262.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,368.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,152.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,262.89
|
| Rate for Payer: Prime Health Services Medicare |
$21,478.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 8166510710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 8166510710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0555006602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| 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 Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| 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: Riverside University Health System MISP |
$0.06
|
| 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 0555006602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| 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 100 MG TABLET [4026]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
NDC 6495021610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
| Rate for Payer: Riverside University Health System MISP |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.82
|
| Rate for Payer: Vantage Medical Group Senior |
$1.82
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 6495021610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.71
|
| Rate for Payer: Cigna of CA HMO |
$1.50
|
| Rate for Payer: Cigna of CA PPO |
$1.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.39
|
| Rate for Payer: Prime Health Services Commercial |
$1.82
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6495021703
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$2.73
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2.10
|
| Rate for Payer: United Healthcare HMO Rider |
$2.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 6495021710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$2.27
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 6495021710
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$2.45
|
| Rate for Payer: Cigna of CA PPO |
$2.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$2.27
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Riverside University Health System MISP |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
