|
ISOTRETINOIN 40 MG CAPSULE [10361]
|
Facility
OP
|
$11.84
|
|
|
Service Code
|
NDC 61748-304-13
|
| Hospital Charge Code |
1710009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7.45
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Central Health Plan Commercial |
$9.47
|
| Rate for Payer: Cigna of CA HMO |
$8.29
|
| Rate for Payer: Cigna of CA PPO |
$8.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$10.06
|
| Rate for Payer: Global Benefits Group Commercial |
$7.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.88
|
| Rate for Payer: IEHP medi-cal |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$8.88
|
| Rate for Payer: Networks By Design Commercial |
$7.70
|
| Rate for Payer: Prime Health Services Commercial |
$10.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.10
|
| Rate for Payer: Riverside University Health MISP |
$4.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.92
|
| Rate for Payer: United Healthcare All Other HMO |
$5.92
|
| Rate for Payer: United Healthcare HMO Rider |
$5.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.06
|
| Rate for Payer: Vantage Medical Group Senior |
$10.06
|
|
|
ISOTRETINOIN 40 MG CAPSULE [10361]
|
Facility
OP
|
$8.30
|
|
|
Service Code
|
NDC 0378-6614-93
|
| Hospital Charge Code |
1710009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.90
|
| Rate for Payer: BCBS Transplant Transplant |
$4.98
|
| Rate for Payer: Blue Shield of California Commercial |
$5.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.06
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Central Health Plan Commercial |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$5.81
|
| Rate for Payer: Cigna of CA PPO |
$5.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.32
|
| Rate for Payer: Galaxy Health WC |
$7.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.22
|
| Rate for Payer: IEHP medi-cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.22
|
| Rate for Payer: Networks By Design Commercial |
$5.40
|
| Rate for Payer: Prime Health Services Commercial |
$7.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.98
|
| Rate for Payer: Riverside University Health MISP |
$3.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Other HMO |
$4.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.06
|
| Rate for Payer: Vantage Medical Group Senior |
$7.06
|
|
|
ISRADIPINE 2.5 MG CAPSULE [10362]
|
Facility
OP
|
$1.73
|
|
|
Service Code
|
NDC 16252-539-01
|
| Hospital Charge Code |
1711608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: BCBS Transplant Transplant |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.30
|
| Rate for Payer: IEHP medi-cal |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: Riverside University Health MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO |
$0.87
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1.47
|
|
|
ISRADIPINE 2.5 MG CAPSULE [10362]
|
Facility
IP
|
$1.73
|
|
|
Service Code
|
NDC 16252-539-01
|
| Hospital Charge Code |
1711608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.47
|
|
|
ISRADIPINE ORAL SUSPENSION COMPOUND 1 MG/ML [4080283]
|
Facility
OP
|
$0.40
|
|
|
Service Code
|
NDC 9994-0802-83
|
| Hospital Charge Code |
1715228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
ISRADIPINE ORAL SUSPENSION COMPOUND 1 MG/ML [4080283]
|
Facility
IP
|
$0.40
|
|
|
Service Code
|
NDC 9994-0802-83
|
| Hospital Charge Code |
1715228
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 65162-630-03
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 65162-630-03
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
OP
|
$33.78
|
|
|
Service Code
|
NDC 50458-290-01
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.96
|
| Rate for Payer: BCBS Transplant Transplant |
$20.27
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Central Health Plan Commercial |
$27.02
|
| Rate for Payer: Cigna of CA HMO |
$23.65
|
| Rate for Payer: Cigna of CA PPO |
$23.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.51
|
| Rate for Payer: Galaxy Health WC |
$28.71
|
| Rate for Payer: Global Benefits Group Commercial |
$20.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.34
|
| Rate for Payer: IEHP medi-cal |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$25.34
|
| Rate for Payer: Networks By Design Commercial |
$21.96
|
| Rate for Payer: Prime Health Services Commercial |
$28.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$20.27
|
| Rate for Payer: Riverside University Health MISP |
$13.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.71
|
| Rate for Payer: Vantage Medical Group Senior |
$28.71
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
IP
|
$33.78
|
|
|
Service Code
|
NDC 50458-290-01
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Shield of California Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California EPN |
$18.04
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Central Health Plan Commercial |
$27.02
|
| Rate for Payer: Cigna of CA HMO |
$23.65
|
| Rate for Payer: Cigna of CA PPO |
$23.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.51
|
| Rate for Payer: Galaxy Health WC |
$28.71
|
| Rate for Payer: Global Benefits Group Commercial |
$20.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$25.34
|
| Rate for Payer: Networks By Design Commercial |
$21.96
|
| Rate for Payer: Prime Health Services Commercial |
$28.71
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 49884-239-11
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 49884-239-11
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
IP
|
$8.93
|
|
|
Service Code
|
NDC 10147-1700-7
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Blue Shield of California Commercial |
$6.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.77
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Central Health Plan Commercial |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$6.25
|
| Rate for Payer: Cigna of CA PPO |
$6.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.59
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$6.70
|
| Rate for Payer: Networks By Design Commercial |
$5.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.59
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
OP
|
$15.10
|
|
|
Service Code
|
NDC 0378-5100-93
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.92
|
| Rate for Payer: BCBS Transplant Transplant |
$9.06
|
| Rate for Payer: Blue Shield of California Commercial |
$9.50
|
| Rate for Payer: Blue Shield of California EPN |
$7.38
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.08
|
| Rate for Payer: Cigna of CA HMO |
$10.57
|
| Rate for Payer: Cigna of CA PPO |
$10.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.84
|
| Rate for Payer: Global Benefits Group Commercial |
$9.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.32
|
| Rate for Payer: IEHP medi-cal |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.82
|
| Rate for Payer: Prime Health Services Commercial |
$12.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.06
|
| Rate for Payer: Riverside University Health MISP |
$6.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.55
|
| Rate for Payer: United Healthcare All Other HMO |
$7.55
|
| Rate for Payer: United Healthcare HMO Rider |
$7.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.84
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
IP
|
$15.10
|
|
|
Service Code
|
NDC 0378-5100-93
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Blue Shield of California Commercial |
$11.32
|
| Rate for Payer: Blue Shield of California EPN |
$8.06
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.08
|
| Rate for Payer: Cigna of CA HMO |
$10.57
|
| Rate for Payer: Cigna of CA PPO |
$10.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.84
|
| Rate for Payer: Global Benefits Group Commercial |
$9.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.82
|
| Rate for Payer: Prime Health Services Commercial |
$12.84
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
OP
|
$8.93
|
|
|
Service Code
|
NDC 10147-1700-7
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.28
|
| Rate for Payer: BCBS Transplant Transplant |
$5.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.37
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Central Health Plan Commercial |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$6.25
|
| Rate for Payer: Cigna of CA PPO |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.59
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.70
|
| Rate for Payer: IEHP medi-cal |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$6.70
|
| Rate for Payer: Networks By Design Commercial |
$5.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: Riverside University Health MISP |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7.59
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 67877-454-30
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ITRACONAZOLE 100 MG CAPSULE [10364]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 67877-454-30
|
| Hospital Charge Code |
1712171
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
NDC 31722-006-31
|
| Hospital Charge Code |
1715991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
NDC 31722-006-31
|
| Hospital Charge Code |
1715991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.40
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.50
|
| Rate for Payer: IEHP medi-cal |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: Riverside University Health MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
OP
|
$2.35
|
|
|
Service Code
|
NDC 65162-087-74
|
| Hospital Charge Code |
1715991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Central Health Plan Commercial |
$1.88
|
| Rate for Payer: Cigna of CA HMO |
$1.64
|
| Rate for Payer: Cigna of CA PPO |
$1.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.76
|
| Rate for Payer: IEHP medi-cal |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: Riverside University Health MISP |
$0.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2.00
|
|
|
ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]
|
Facility
IP
|
$2.35
|
|
|
Service Code
|
NDC 65162-087-74
|
| Hospital Charge Code |
1715991
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.25
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Central Health Plan Commercial |
$1.88
|
| Rate for Payer: Cigna of CA HMO |
$1.64
|
| Rate for Payer: Cigna of CA PPO |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.94
|
| Rate for Payer: Galaxy Health WC |
$2.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.76
|
| Rate for Payer: Networks By Design Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$2.00
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
OP
|
$11.36
|
|
|
Service Code
|
NDC 55513-800-60
|
| Hospital Charge Code |
ERX204605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.71
|
| Rate for Payer: BCBS Transplant Transplant |
$6.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Central Health Plan Commercial |
$9.09
|
| Rate for Payer: Cigna of CA HMO |
$7.95
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.52
|
| Rate for Payer: IEHP medi-cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: Riverside University Health MISP |
$4.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
IVABRADINE 5 MG TABLET [204605]
|
Facility
IP
|
$11.36
|
|
|
Service Code
|
NDC 55513-800-60
|
| Hospital Charge Code |
ERX204605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Blue Shield of California Commercial |
$8.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Central Health Plan Commercial |
$9.09
|
| Rate for Payer: Cigna of CA HMO |
$7.95
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
|
|
IVABRADINE 7.5 MG TABLET [204608]
|
Facility
OP
|
$11.36
|
|
|
Service Code
|
NDC 55513-810-60
|
| Hospital Charge Code |
ERX204608
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.71
|
| Rate for Payer: BCBS Transplant Transplant |
$6.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7.15
|
| Rate for Payer: Blue Shield of California EPN |
$5.56
|
| Rate for Payer: Cash Price |
$5.11
|
| Rate for Payer: Central Health Plan Commercial |
$9.09
|
| Rate for Payer: Cigna of CA HMO |
$7.95
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.54
|
| Rate for Payer: Galaxy Health WC |
$9.66
|
| Rate for Payer: Global Benefits Group Commercial |
$6.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.52
|
| Rate for Payer: IEHP medi-cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$8.52
|
| Rate for Payer: Networks By Design Commercial |
$7.38
|
| Rate for Payer: Prime Health Services Commercial |
$9.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: Riverside University Health MISP |
$4.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.66
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
