|
IOPAMIDOL 41% INTRATHECAL SOLUTION FOR RADIOLOGY [40810325]
|
Facility
OP
|
$7.76
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
NDG10325A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$4.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4.88
|
| Rate for Payer: Blue Shield of California EPN |
$3.79
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Central Health Plan Commercial |
$6.21
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.10
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.82
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
| Rate for Payer: Riverside University Health MISP |
$3.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3.88
|
| Rate for Payer: United Healthcare HMO Rider |
$3.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Vantage Medical Group Senior |
$6.60
|
|
|
IOPAMIDOL 41% INTRATHECAL SOLUTION FOR RADIOLOGY [40810325]
|
Facility
IP
|
$7.76
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
NDG10325A
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: Blue Shield of California Commercial |
$5.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.14
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Central Health Plan Commercial |
$6.21
|
| Rate for Payer: Cigna of CA HMO |
$5.43
|
| Rate for Payer: Cigna of CA PPO |
$5.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.10
|
| Rate for Payer: Galaxy Health WC |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Networks By Design Commercial |
$3.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.60
|
|
|
IOPAMIDOL 41% INTRATHECAL SOLUTION FOR RADIOLOGY [40810325]
|
Facility
IP
|
$5.31
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
NDG10325B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Blue Shield of California Commercial |
$3.98
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Central Health Plan Commercial |
$4.25
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$4.51
|
|
|
IOPAMIDOL 41% INTRATHECAL SOLUTION FOR RADIOLOGY [40810325]
|
Facility
OP
|
$5.31
|
|
|
Service Code
|
CPT Q9966
|
| Hospital Charge Code |
NDG10325B
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Central Health Plan Commercial |
$4.25
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.12
|
| Rate for Payer: Galaxy Health WC |
$4.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.98
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.98
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$4.51
|
| Rate for Payer: Riverside University Health MISP |
$2.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.51
|
| Rate for Payer: Vantage Medical Group Senior |
$4.51
|
|
|
IOPAMIDOL 61 % INTRAVENOUS SOLUTION MULTIDOSE [40827737]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG27737G
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
IOPAMIDOL 61 % INTRAVENOUS SOLUTION MULTIDOSE [40827737]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG27737G
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
IP
|
$0.56
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328D
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328G
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
OP
|
$0.56
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328D
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.42
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328C
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328A
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
IP
|
$0.61
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328A
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328G
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
IOPAMIDOL 76% INTRAVENOUS SOLUTION MULTIDOSE [40810328]
|
Facility
OP
|
$0.61
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
NDG10328C
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.84
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.52
|
| Rate for Payer: Vantage Medical Group Senior |
$0.52
|
|
|
IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION [10333]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
CPT Q9961
|
| Hospital Charge Code |
NDG10333
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| 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: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION [10333]
|
Facility
OP
|
$0.49
|
|
|
Service Code
|
CPT Q9961
|
| Hospital Charge Code |
NDG10333
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.56 |
| 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 Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.37
|
| Rate for Payer: IEHP medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| 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: Riverside University Health MISP |
$0.20
|
| 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 Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION [10333]
|
Facility
IP
|
$0.29
|
|
|
Service Code
|
CPT Q9961
|
| Hospital Charge Code |
NDG10333A
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
|
|
IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION [10333]
|
Facility
OP
|
$0.29
|
|
|
Service Code
|
CPT Q9961
|
| Hospital Charge Code |
NDG10333A
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.56
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.25
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.22
|
| Rate for Payer: IEHP medi-cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.19
|
| Rate for Payer: Prime Health Services Commercial |
$0.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| 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 Medi-Cal |
$0.25
|
| Rate for Payer: Vantage Medical Group Senior |
$0.25
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [108955]
|
Facility
IP
|
$1,003.82
|
|
|
Service Code
|
CPT J9228
|
| Hospital Charge Code |
1755778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.76 |
| Max. Negotiated Rate |
$903.44 |
| Rate for Payer: Blue Shield of California Commercial |
$752.86
|
| Rate for Payer: Blue Shield of California EPN |
$536.04
|
| Rate for Payer: Cash Price |
$451.72
|
| Rate for Payer: Central Health Plan Commercial |
$803.06
|
| Rate for Payer: Cigna of CA HMO |
$702.67
|
| Rate for Payer: Cigna of CA PPO |
$702.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$401.53
|
| Rate for Payer: Galaxy Health WC |
$853.25
|
| Rate for Payer: Global Benefits Group Commercial |
$602.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$752.86
|
| Rate for Payer: Networks By Design Commercial |
$501.91
|
| Rate for Payer: Prime Health Services Commercial |
$853.25
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [108955]
|
Facility
OP
|
$1,003.82
|
|
|
Service Code
|
CPT J9228
|
| Hospital Charge Code |
1755778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$1,068.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$172.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,068.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$189.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$189.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$237.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.97
|
| Rate for Payer: BCBS Transplant Transplant |
$602.29
|
| Rate for Payer: Blue Shield of California Commercial |
$198.03
|
| Rate for Payer: Blue Shield of California EPN |
$180.03
|
| Rate for Payer: Caremore Medicare Advantage |
$172.42
|
| Rate for Payer: Cash Price |
$451.72
|
| Rate for Payer: Cash Price |
$451.72
|
| Rate for Payer: Central Health Plan Commercial |
$803.06
|
| Rate for Payer: Cigna of CA HMO |
$702.67
|
| Rate for Payer: Cigna of CA PPO |
$702.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$172.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.42
|
| Rate for Payer: Galaxy Health WC |
$853.25
|
| Rate for Payer: Global Benefits Group Commercial |
$602.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$752.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$282.77
|
| Rate for Payer: IEHP medi-cal |
$284.49
|
| Rate for Payer: IEHP Medicare Advantage |
$172.42
|
| Rate for Payer: Innovage PACE Commercial |
$258.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.04
|
| Rate for Payer: Multiplan Commercial |
$752.86
|
| Rate for Payer: Networks By Design Commercial |
$501.91
|
| Rate for Payer: Prime Health Services Commercial |
$853.25
|
| Rate for Payer: Prime Health Services Medicare |
$182.76
|
| Rate for Payer: Riverside University Health MISP |
$189.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$501.91
|
| Rate for Payer: United Healthcare All Other HMO |
$501.91
|
| Rate for Payer: United Healthcare HMO Rider |
$501.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$258.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.66
|
| Rate for Payer: Vantage Medical Group Senior |
$172.42
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-79
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
IP
|
$0.96
|
|
|
Service Code
|
NDC 0487-0201-01
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Blue Shield of California Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California EPN |
$0.51
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.77
|
| Rate for Payer: Cigna of CA HMO |
$0.67
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Galaxy Health WC |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$0.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.62
|
| Rate for Payer: Prime Health Services Commercial |
$0.82
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 0378-9671-93
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-83
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-79
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
