|
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: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Blue Shield of California Commercial |
$12.05
|
| Rate for Payer: Blue Shield of California Commercial |
$11.36
|
| Rate for Payer: Blue Shield of California EPN |
$7.40
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Central Health Plan Commercial |
$12.47
|
| Rate for Payer: Central Health Plan Commercial |
$11.75
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA HMO |
$10.91
|
| Rate for Payer: Cigna of CA PPO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5.88
|
| Rate for Payer: EPIC Health Plan Senior |
$6.24
|
| Rate for Payer: Galaxy Health WC |
$12.49
|
| Rate for Payer: Galaxy Health WC |
$13.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$7.34
|
| Rate for Payer: Networks By Design Commercial |
$7.79
|
| Rate for Payer: Prime Health Services Commercial |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$12.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.51
|
| 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 All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.11
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
IP
|
$208.78
|
|
|
Service Code
|
HCPCS J9227
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$187.90 |
| Rate for Payer: Adventist Health Commercial |
$41.76
|
| Rate for Payer: Blue Shield of California Commercial |
$161.39
|
| Rate for Payer: Blue Shield of California EPN |
$105.23
|
| Rate for Payer: Cash Price |
$114.83
|
| Rate for Payer: Central Health Plan Commercial |
$167.02
|
| Rate for Payer: Cigna of CA HMO |
$146.15
|
| Rate for Payer: Cigna of CA PPO |
$146.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.51
|
| Rate for Payer: EPIC Health Plan Senior |
$83.51
|
| Rate for Payer: Galaxy Health WC |
$177.46
|
| Rate for Payer: Global Benefits Group Commercial |
$125.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$156.59
|
| Rate for Payer: Networks By Design Commercial |
$104.39
|
| Rate for Payer: Prime Health Services Commercial |
$177.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.36
|
| Rate for Payer: United Healthcare All Other HMO |
$76.27
|
| Rate for Payer: United Healthcare HMO Rider |
$74.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.38
|
|
|
ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION [227445]
|
Facility
|
OP
|
$208.78
|
|
|
Service Code
|
HCPCS J9227
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$187.90 |
| Rate for Payer: Adventist Health Commercial |
$41.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$82.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Blue Shield of California Commercial |
$104.48
|
| Rate for Payer: Blue Shield of California EPN |
$94.98
|
| Rate for Payer: Cash Price |
$114.83
|
| Rate for Payer: Cash Price |
$114.83
|
| Rate for Payer: Central Health Plan Commercial |
$167.02
|
| Rate for Payer: Cigna of CA HMO |
$146.15
|
| Rate for Payer: Cigna of CA PPO |
$146.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.86
|
| Rate for Payer: EPIC Health Plan Senior |
$82.86
|
| Rate for Payer: Galaxy Health WC |
$177.46
|
| Rate for Payer: Global Benefits Group Commercial |
$125.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$135.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82.86
|
| Rate for Payer: InnovAge PACE Commercial |
$124.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$139.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$111.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$111.03
|
| Rate for Payer: Multiplan Commercial |
$156.59
|
| Rate for Payer: Networks By Design Commercial |
$104.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$82.86
|
| Rate for Payer: Prime Health Services Commercial |
$177.46
|
| Rate for Payer: Prime Health Services Medicare |
$87.83
|
| Rate for Payer: Riverside University Health System MISP |
$91.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.36
|
| Rate for Payer: United Healthcare All Other HMO |
$76.27
|
| Rate for Payer: United Healthcare HMO Rider |
$74.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$82.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.15
|
| Rate for Payer: Vantage Medical Group Senior |
$91.15
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
IP
|
$138.90
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$70.01
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Central Health Plan Commercial |
$111.12
|
| Rate for Payer: Cigna of CA HMO |
$97.23
|
| Rate for Payer: Cigna of CA PPO |
$97.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.56
|
| Rate for Payer: EPIC Health Plan Senior |
$55.56
|
| Rate for Payer: Galaxy Health WC |
$118.06
|
| Rate for Payer: Global Benefits Group Commercial |
$83.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.78
|
| Rate for Payer: Multiplan Commercial |
$104.17
|
| Rate for Payer: Networks By Design Commercial |
$90.28
|
| Rate for Payer: Prime Health Services Commercial |
$118.06
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
IP
|
$138.90
|
|
|
Service Code
|
NDC 0469-0520-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$70.01
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Central Health Plan Commercial |
$111.12
|
| Rate for Payer: Cigna of CA HMO |
$97.23
|
| Rate for Payer: Cigna of CA PPO |
$97.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.56
|
| Rate for Payer: EPIC Health Plan Senior |
$55.56
|
| Rate for Payer: Galaxy Health WC |
$118.06
|
| Rate for Payer: Global Benefits Group Commercial |
$83.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.78
|
| Rate for Payer: Multiplan Commercial |
$104.17
|
| Rate for Payer: Networks By Design Commercial |
$90.28
|
| Rate for Payer: Prime Health Services Commercial |
$118.06
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
OP
|
$138.90
|
|
|
Service Code
|
NDC 0469-0520-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$76.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.58
|
| Rate for Payer: Blue Shield of California Commercial |
$84.87
|
| Rate for Payer: Blue Shield of California EPN |
$55.42
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Central Health Plan Commercial |
$111.12
|
| Rate for Payer: Cigna of CA HMO |
$97.23
|
| Rate for Payer: Cigna of CA PPO |
$97.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$118.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.56
|
| Rate for Payer: EPIC Health Plan Senior |
$55.56
|
| Rate for Payer: Galaxy Health WC |
$118.06
|
| Rate for Payer: Global Benefits Group Commercial |
$83.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.01
|
| Rate for Payer: InnovAge PACE Commercial |
$69.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97.23
|
| Rate for Payer: Multiplan Commercial |
$104.17
|
| Rate for Payer: Networks By Design Commercial |
$90.28
|
| Rate for Payer: Prime Health Services Commercial |
$118.06
|
| Rate for Payer: Riverside University Health System MISP |
$55.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.45
|
| Rate for Payer: United Healthcare All Other HMO |
$69.45
|
| Rate for Payer: United Healthcare HMO Rider |
$69.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.06
|
| Rate for Payer: Vantage Medical Group Senior |
$118.06
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE [209331]
|
Facility
|
OP
|
$138.90
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$76.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.58
|
| Rate for Payer: Blue Shield of California Commercial |
$84.87
|
| Rate for Payer: Blue Shield of California EPN |
$55.42
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Central Health Plan Commercial |
$111.12
|
| Rate for Payer: Cigna of CA HMO |
$97.23
|
| Rate for Payer: Cigna of CA PPO |
$97.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$118.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.56
|
| Rate for Payer: EPIC Health Plan Senior |
$55.56
|
| Rate for Payer: Galaxy Health WC |
$118.06
|
| Rate for Payer: Global Benefits Group Commercial |
$83.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.01
|
| Rate for Payer: InnovAge PACE Commercial |
$69.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97.23
|
| Rate for Payer: Multiplan Commercial |
$104.17
|
| Rate for Payer: Networks By Design Commercial |
$90.28
|
| Rate for Payer: Prime Health Services Commercial |
$118.06
|
| Rate for Payer: Riverside University Health System MISP |
$55.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.45
|
| Rate for Payer: United Healthcare All Other HMO |
$69.45
|
| Rate for Payer: United Healthcare HMO Rider |
$69.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.06
|
| Rate for Payer: Vantage Medical Group Senior |
$118.06
|
|
|
ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION [209328]
|
Facility
|
OP
|
$473.26
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$425.93 |
| Rate for Payer: Adventist Health Commercial |
$94.65
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| 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 |
$260.29
|
| Rate for Payer: Cash Price |
$260.29
|
| Rate for Payer: Central Health Plan Commercial |
$378.61
|
| Rate for Payer: Cigna of CA HMO |
$331.28
|
| Rate for Payer: Cigna of CA PPO |
$331.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: EPIC Health Plan Senior |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$402.27
|
| Rate for Payer: Global Benefits Group Commercial |
$283.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.01
|
| Rate for Payer: InnovAge PACE Commercial |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$354.94
|
| Rate for Payer: Networks By Design Commercial |
$236.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$402.27
|
| Rate for Payer: Prime Health Services Medicare |
$1.07
|
| Rate for Payer: Riverside University Health System MISP |
$1.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.61
|
| Rate for Payer: United Healthcare All Other HMO |
$172.88
|
| Rate for Payer: United Healthcare HMO Rider |
$169.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION [209328]
|
Facility
|
IP
|
$473.26
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.65 |
| Max. Negotiated Rate |
$425.93 |
| Rate for Payer: Adventist Health Commercial |
$94.65
|
| Rate for Payer: Blue Shield of California Commercial |
$365.83
|
| Rate for Payer: Blue Shield of California EPN |
$238.52
|
| Rate for Payer: Cash Price |
$260.29
|
| Rate for Payer: Central Health Plan Commercial |
$378.61
|
| Rate for Payer: Cigna of CA HMO |
$331.28
|
| Rate for Payer: Cigna of CA PPO |
$331.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.30
|
| Rate for Payer: EPIC Health Plan Senior |
$189.30
|
| Rate for Payer: Galaxy Health WC |
$402.27
|
| Rate for Payer: Global Benefits Group Commercial |
$283.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.65
|
| Rate for Payer: Multiplan Commercial |
$354.94
|
| Rate for Payer: Networks By Design Commercial |
$236.63
|
| Rate for Payer: Prime Health Services Commercial |
$402.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.61
|
| Rate for Payer: United Healthcare All Other HMO |
$172.88
|
| Rate for Payer: United Healthcare HMO Rider |
$169.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.99
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| 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 |
$0.08
|
| 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: 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: InnovAge PACE Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.10
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$2.14
|
|
|
Service Code
|
NDC 64950-216-10
|
| 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 |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$1.17
|
| 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: 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: InnovAge PACE Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| 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 |
$0.08
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$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
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 64950-216-10
|
| 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 |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$1.17
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| 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 64950-217-03
|
| 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 |
$2.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$2.31
|
| 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: 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: InnovAge PACE Commercial |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA 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 64950-217-10
|
| 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 |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.93
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| 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
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 64950-217-03
|
| 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: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$2.31
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| 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
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 64950-217-10
|
| 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 |
$2.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.93
|
| 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: 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: InnovAge PACE Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.45
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: InnovAge PACE Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.72
|
| Rate for Payer: Riverside University Health System MISP |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Vantage Medical Group Senior |
$0.72
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Central Health Plan Commercial |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: Galaxy Health WC |
$0.72
|
| Rate for Payer: Global Benefits Group Commercial |
$0.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: Networks By Design Commercial |
$0.55
|
| Rate for Payer: Prime Health Services Commercial |
$0.72
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$10.26
|
| Rate for Payer: Blue Shield of California EPN |
$6.70
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$10.75
|
| Rate for Payer: Cigna of CA PPO |
$12.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: InnovAge PACE Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.92
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Riverside University Health System MISP |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$10.26
|
| Rate for Payer: Blue Shield of California EPN |
$6.70
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: Cigna of CA HMO |
$10.75
|
| Rate for Payer: Cigna of CA PPO |
$12.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: InnovAge PACE Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.92
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
| Rate for Payer: Riverside University Health System MISP |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$37.10
|
| Rate for Payer: Blue Shield of California EPN |
$24.19
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| 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
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$12.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.92
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$12.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.47
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Central Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.28
|
| Rate for Payer: Global Benefits Group Commercial |
$10.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.92
|
| Rate for Payer: Prime Health Services Commercial |
$14.28
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.19
|
| Rate for Payer: Blue Shield of California Commercial |
$29.33
|
| Rate for Payer: Blue Shield of California EPN |
$19.15
|
| Rate for Payer: Cash Price |
$26.40
|
| 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: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| 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 System 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 Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
