|
ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION [209328]
|
Facility
|
IP
|
$473.26
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.66 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Adventist Health Commercial |
$94.65
|
| Rate for Payer: Cash Price |
$260.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.12
|
| Rate for Payer: Heritage Provider Network Senior |
$219.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.31
|
| Rate for Payer: Multiplan Commercial |
$354.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.70
|
|
|
ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION [209328]
|
Facility
|
OP
|
$473.26
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Adventist Health Commercial |
$94.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$252.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$260.29
|
| Rate for Payer: Cash Price |
$260.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: Dignity Health Senior |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.12
|
| Rate for Payer: Heritage Provider Network Senior |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$354.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$189.30
|
| Rate for Payer: TriValley Medical Group Senior |
$189.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 64950-216-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
NDC 64950-216-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.82
|
| Rate for Payer: Dignity Health Senior |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.86
|
| Rate for Payer: TriValley Medical Group Senior |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.82
|
| Rate for Payer: Vantage Medical Group Senior |
$1.82
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Senior |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| 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 |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
ISONIAZID 100 MG TABLET [4026]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0555-0066-02
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| 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 |
$0.11
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 64950-217-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 64950-217-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.98
|
| Rate for Payer: Dignity Health Senior |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 64950-217-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Senior |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
ISONIAZID 300 MG TABLET [4027]
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 64950-217-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Adventist Health Commercial |
$0.70
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
|
|
ISONIAZID 50 MG/5 ML ORAL SOLUTION [4025]
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 46287-009-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.72
|
| Rate for Payer: Dignity Health Senior |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Vantage Medical Group Senior |
$0.72
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.37
|
| Rate for Payer: Heritage Provider Network Senior |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.37
|
| Rate for Payer: Heritage Provider Network Senior |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.20
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Senior |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.40
|
| Rate for Payer: Heritage Provider Network Senior |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.72
|
| Rate for Payer: TriValley Medical Group Senior |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION [110292]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 72485-113-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.20
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Senior |
$14.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.40
|
| Rate for Payer: Heritage Provider Network Senior |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.72
|
| Rate for Payer: TriValley Medical Group Senior |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.28
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION FOR DRIPS [48110292]
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 0548-9502-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
NDC 52536-006-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
OP
|
$5.50
|
|
|
Service Code
|
NDC 24338-010-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.68
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.67
|
| Rate for Payer: Dignity Health Senior |
$4.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.40
|
| Rate for Payer: Heritage Provider Network Senior |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.85
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.67
|
| Rate for Payer: Vantage Medical Group Senior |
$4.67
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 52536-006-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.81
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.12
|
| Rate for Payer: Dignity Health Senior |
$1.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.82
|
| Rate for Payer: Heritage Provider Network Senior |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1.12
|
|
|
ISOSORBIDE 20 MG-HYDRALAZINE 37.5 MG TABLET [41893]
|
Facility
|
IP
|
$5.50
|
|
|
Service Code
|
NDC 24338-010-09
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.72
|
| Rate for Payer: Heritage Provider Network Senior |
$3.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.12
|
|
|
ISOSORBIDE DINITRATE 10 MG TABLET [4064]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 68001-374-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
|
