|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
OP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0654-01
|
| Hospital Charge Code |
NDG227445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.82
|
| Rate for Payer: BCBS Transplant Transplant |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$113.73
|
| Rate for Payer: Blue Shield of California EPN |
$88.42
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Central Health Plan Commercial |
$144.65
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135.61
|
| Rate for Payer: IEHP medi-cal |
$63.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.16
|
| Rate for Payer: Multiplan Commercial |
$135.61
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
| Rate for Payer: Riverside University Health MISP |
$72.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.40
|
| Rate for Payer: United Healthcare All Other HMO |
$90.40
|
| Rate for Payer: United Healthcare HMO Rider |
$90.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.69
|
| Rate for Payer: Vantage Medical Group Senior |
$153.69
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
IP
|
$180.81
|
|
|
Service Code
|
NDC 0024-0654-01
|
| Hospital Charge Code |
NDG227445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Blue Shield of California Commercial |
$135.61
|
| Rate for Payer: Blue Shield of California EPN |
$96.55
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Central Health Plan Commercial |
$144.65
|
| Rate for Payer: Cigna of CA HMO |
$126.57
|
| Rate for Payer: Cigna of CA PPO |
$126.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.32
|
| Rate for Payer: Galaxy Health WC |
$153.69
|
| Rate for Payer: Global Benefits Group Commercial |
$108.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.16
|
| Rate for Payer: Multiplan Commercial |
$135.61
|
| Rate for Payer: Networks By Design Commercial |
$90.40
|
| Rate for Payer: Prime Health Services Commercial |
$153.69
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
IP
|
$128.43
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
ERX209331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$115.59 |
| Rate for Payer: Blue Shield of California Commercial |
$96.32
|
| Rate for Payer: Blue Shield of California EPN |
$68.58
|
| Rate for Payer: Cash Price |
$57.79
|
| Rate for Payer: Central Health Plan Commercial |
$102.74
|
| Rate for Payer: Cigna of CA HMO |
$89.90
|
| Rate for Payer: Cigna of CA PPO |
$89.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.37
|
| Rate for Payer: Galaxy Health WC |
$109.17
|
| Rate for Payer: Global Benefits Group Commercial |
$77.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.69
|
| Rate for Payer: Multiplan Commercial |
$96.32
|
| Rate for Payer: Networks By Design Commercial |
$83.48
|
| Rate for Payer: Prime Health Services Commercial |
$109.17
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
OP
|
$128.43
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
ERX209331
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$115.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.88
|
| Rate for Payer: BCBS Transplant Transplant |
$77.06
|
| Rate for Payer: Blue Shield of California Commercial |
$80.78
|
| Rate for Payer: Blue Shield of California EPN |
$62.80
|
| Rate for Payer: Cash Price |
$57.79
|
| Rate for Payer: Central Health Plan Commercial |
$102.74
|
| Rate for Payer: Cigna of CA HMO |
$89.90
|
| Rate for Payer: Cigna of CA PPO |
$89.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.37
|
| Rate for Payer: Galaxy Health WC |
$109.17
|
| Rate for Payer: Global Benefits Group Commercial |
$77.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.32
|
| Rate for Payer: IEHP medi-cal |
$44.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.69
|
| Rate for Payer: Multiplan Commercial |
$96.32
|
| Rate for Payer: Networks By Design Commercial |
$83.48
|
| Rate for Payer: Prime Health Services Commercial |
$109.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$77.06
|
| Rate for Payer: Riverside University Health MISP |
$51.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.22
|
| Rate for Payer: United Healthcare All Other HMO |
$64.22
|
| Rate for Payer: United Healthcare HMO Rider |
$64.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.17
|
| Rate for Payer: Vantage Medical Group Senior |
$109.17
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
IP
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| Hospital Charge Code |
1710461
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| 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: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| 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
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| Hospital Charge Code |
1710461
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: BCBS Transplant Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| 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: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
OP
|
$0.49
|
|
|
Service Code
|
NDC 0555-0071-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| 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 |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: BCBS Transplant Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: 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
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 0555-0071-02
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: IEHP medi-cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Riverside University Health MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 0555-0071-02
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
IP
|
$0.49
|
|
|
Service Code
|
NDC 0555-0071-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| 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: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: 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
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
IP
|
$1.24
|
|
|
Service Code
|
NDC 51079-083-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
OP
|
$1.24
|
|
|
Service Code
|
NDC 51079-083-01
|
| Hospital Charge Code |
1710467
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: BCBS Transplant Transplant |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Central Health Plan Commercial |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$0.87
|
| Rate for Payer: Cigna of CA PPO |
$0.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.93
|
| Rate for Payer: IEHP medi-cal |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: Riverside University Health MISP |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
IP
|
$0.74
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
1715021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
OP
|
$0.74
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
1715021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.44
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Central Health Plan Commercial |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.52
|
| Rate for Payer: Cigna of CA PPO |
$0.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.30
|
| Rate for Payer: Galaxy Health WC |
$0.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.56
|
| Rate for Payer: IEHP medi-cal |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.56
|
| Rate for Payer: Networks By Design Commercial |
$0.48
|
| Rate for Payer: Prime Health Services Commercial |
$0.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Riverside University Health MISP |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.63
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
IP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-31
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.36
|
| Rate for Payer: BCBS Transplant Transplant |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.19
|
| Rate for Payer: Blue Shield of California EPN |
$23.47
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$36.00
|
| Rate for Payer: IEHP medi-cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Riverside University Health MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
OP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.10
|
| Rate for Payer: BCBS Transplant Transplant |
$24.48
|
| Rate for Payer: Blue Shield of California Commercial |
$25.66
|
| Rate for Payer: Blue Shield of California EPN |
$19.95
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Central Health Plan Commercial |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$26.11
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.60
|
| Rate for Payer: IEHP medi-cal |
$14.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$30.60
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
| Rate for Payer: Riverside University Health MISP |
$16.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO |
$20.40
|
| Rate for Payer: United Healthcare HMO Rider |
$20.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.68
|
| Rate for Payer: Vantage Medical Group Senior |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
IP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Blue Shield of California Commercial |
$30.60
|
| Rate for Payer: Blue Shield of California EPN |
$21.79
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Central Health Plan Commercial |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$30.60
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
OP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.10
|
| Rate for Payer: BCBS Transplant Transplant |
$24.48
|
| Rate for Payer: Blue Shield of California Commercial |
$25.66
|
| Rate for Payer: Blue Shield of California EPN |
$19.95
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Central Health Plan Commercial |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$26.11
|
| Rate for Payer: Cigna of CA PPO |
$30.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.60
|
| Rate for Payer: IEHP medi-cal |
$14.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$30.60
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
| Rate for Payer: Riverside University Health MISP |
$16.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO |
$20.40
|
| Rate for Payer: United Healthcare HMO Rider |
$20.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.68
|
| Rate for Payer: Vantage Medical Group Senior |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
IP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-42
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
IP
|
$40.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Blue Shield of California Commercial |
$30.60
|
| Rate for Payer: Blue Shield of California EPN |
$21.79
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Central Health Plan Commercial |
$32.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: Galaxy Health WC |
$34.68
|
| Rate for Payer: Global Benefits Group Commercial |
$24.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$30.60
|
| Rate for Payer: Networks By Design Commercial |
$26.52
|
| Rate for Payer: Prime Health Services Commercial |
$34.68
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California EPN |
$25.63
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
OP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-31
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.85
|
| Rate for Payer: BCBS Transplant Transplant |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$21.13
|
| Rate for Payer: Blue Shield of California EPN |
$16.43
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$21.50
|
| Rate for Payer: Cigna of CA PPO |
$24.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.20
|
| Rate for Payer: IEHP medi-cal |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
OP
|
$33.60
|
|
|
Service Code
|
NDC 23155-661-42
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.85
|
| Rate for Payer: BCBS Transplant Transplant |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$21.13
|
| Rate for Payer: Blue Shield of California EPN |
$16.43
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$21.50
|
| Rate for Payer: Cigna of CA PPO |
$24.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.20
|
| Rate for Payer: IEHP medi-cal |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$21.84
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
1720174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California EPN |
$25.63
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
