|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Senior |
$6.94
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$3.26
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.57
|
| Rate for Payer: Dignity Health Senior |
$6.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.58
|
| Rate for Payer: Heritage Provider Network Senior |
$3.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$5.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.09
|
| Rate for Payer: TriValley Medical Group Senior |
$3.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.57
|
| Rate for Payer: Vantage Medical Group Senior |
$6.57
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Adventist Health Commercial |
$1.55
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.58
|
| Rate for Payer: Heritage Provider Network Senior |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$5.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.56
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
IP
|
$357.48
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Adventist Health Commercial |
$71.50
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.51
|
| Rate for Payer: Heritage Provider Network Senior |
$165.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.37
|
| Rate for Payer: Multiplan Commercial |
$268.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.36
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
OP
|
$357.48
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Adventist Health Commercial |
$71.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$191.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.42
|
| Rate for Payer: Blue Shield of California Commercial |
$68.94
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.78
|
| Rate for Payer: Dignity Health Senior |
$71.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.51
|
| Rate for Payer: Heritage Provider Network Senior |
$165.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$170.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.22
|
| Rate for Payer: Multiplan Commercial |
$268.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.99
|
| Rate for Payer: TriValley Medical Group Senior |
$142.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.78
|
| Rate for Payer: Vantage Medical Group Senior |
$71.78
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 4601709660
|
| 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: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.36
|
| Rate for Payer: Heritage Provider Network Senior |
$10.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: Multiplan Commercial |
$16.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.41
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$48.28 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.28
|
| Rate for Payer: Blue Shield of California Commercial |
$18.11
|
| Rate for Payer: Blue Shield of California EPN |
$18.11
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.83
|
| Rate for Payer: Dignity Health Senior |
$19.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.36
|
| Rate for Payer: Heritage Provider Network Senior |
$10.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.71
|
| Rate for Payer: Multiplan Commercial |
$16.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.95
|
| Rate for Payer: TriValley Medical Group Senior |
$8.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.83
|
| Rate for Payer: Vantage Medical Group Senior |
$19.83
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
|
IP
|
$15.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$3.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.00
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: Dignity Health Senior |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.24
|
| Rate for Payer: TriValley Medical Group Senior |
$6.24
|
| Rate for Payer: TriValley Medical Group Senior |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6.00
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
Facility
|
OP
|
$15.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$13.25 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.25
|
| Rate for Payer: Dignity Health Senior |
$12.49
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.49
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
Facility
|
IP
|
$14.69
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.86
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION [121793]
|
Facility
|
OP
|
$15.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$13.25 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.25
|
| Rate for Payer: Dignity Health Senior |
$12.49
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$6.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.49
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION [121793]
|
Facility
|
IP
|
$14.69
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$6.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.86
|
|
|
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 |
$37.79 |
| Max. Negotiated Rate |
$156.59 |
| Rate for Payer: Adventist Health Commercial |
$41.76
|
| Rate for Payer: Cash Price |
$114.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.67
|
| Rate for Payer: Heritage Provider Network Senior |
$96.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$156.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.13
|
|
|
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 |
$37.79 |
| Max. Negotiated Rate |
$218.31 |
| Rate for Payer: Adventist Health Commercial |
$41.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.43
|
| 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 |
$91.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.31
|
| Rate for Payer: Blue Shield of California Commercial |
$80.73
|
| Rate for Payer: Blue Shield of California EPN |
$80.73
|
| Rate for Payer: Cash Price |
$114.83
|
| Rate for Payer: Cash Price |
$114.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.15
|
| Rate for Payer: Dignity Health Senior |
$91.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$82.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.67
|
| Rate for Payer: Heritage Provider Network Senior |
$96.67
|
| 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: Kaiser Permanente of CA Commercial |
$99.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$156.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.51
|
| Rate for Payer: TriValley Medical Group Senior |
$83.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.13
|
| 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 0469-0520-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$104.17 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.04
|
| Rate for Payer: Heritage Provider Network Senior |
$94.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.73
|
| Rate for Payer: Multiplan Commercial |
$104.17
|
|
|
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 |
$25.14 |
| Max. Negotiated Rate |
$118.06 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.42
|
| 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: Blue Shield of California Commercial |
$84.73
|
| Rate for Payer: Blue Shield of California EPN |
$67.78
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.06
|
| Rate for Payer: Dignity Health Senior |
$118.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.98
|
| Rate for Payer: Heritage Provider Network Senior |
$85.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.73
|
| 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: TriValley Medical Group Commercial |
$55.56
|
| Rate for Payer: TriValley Medical Group Senior |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$138.90
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$104.17 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.04
|
| Rate for Payer: Heritage Provider Network Senior |
$94.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.73
|
| Rate for Payer: Multiplan Commercial |
$104.17
|
|
|
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 |
$25.14 |
| Max. Negotiated Rate |
$118.06 |
| Rate for Payer: Adventist Health Commercial |
$27.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.42
|
| 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: Blue Shield of California Commercial |
$84.73
|
| Rate for Payer: Blue Shield of California EPN |
$67.78
|
| Rate for Payer: Cash Price |
$76.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.06
|
| Rate for Payer: Dignity Health Senior |
$118.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.98
|
| Rate for Payer: Heritage Provider Network Senior |
$85.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.73
|
| 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: TriValley Medical Group Commercial |
$55.56
|
| Rate for Payer: TriValley Medical Group Senior |
$55.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
