|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
IP
|
$28.54
|
|
|
Service Code
|
NDC 0597008717
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$21.41 |
| Rate for Payer: Adventist Health Commercial |
$5.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.38
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.32
|
| Rate for Payer: Heritage Provider Network Senior |
$19.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$21.41
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 2420839830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.94
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.99
|
| Rate for Payer: Heritage Provider Network Senior |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 2420839830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Senior |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0054004544
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.93
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Senior |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 0054004544
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.58
|
| Rate for Payer: TriValley Medical Group Senior |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
NDC 0054004641
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.41
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.15
|
| Rate for Payer: TriValley Medical Group Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2.45
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 2420839915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.88
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 2420839915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.17
|
| Rate for Payer: TriValley Medical Group Senior |
$1.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054004641
|
| 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: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Cash Price |
$1.30
|
| 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 Foundation Hospitals 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 3334204710
|
| 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: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| 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 Foundation Hospitals 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 3334204710
|
| 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 Non-Gatekeeper |
$0.15
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| 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 |
$0.11
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$3.60
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$322.89 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.94
|
| 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 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 |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.89
|
| 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 |
$1.94
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| 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 |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| 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 |
$2.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.78
|
| 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 Foundation Hospitals Commercial |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.26
|
| Rate for Payer: TriValley Medical Group Senior |
$3.26
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| 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 All Other HMO/non HMO |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.94
|
| 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 Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| 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
|
$8.16
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.62
|
| 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: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| 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 Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Foundation Hospitals 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: 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
|
$8.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$322.89 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.89
|
| 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 |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.15
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.65
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
OP
|
$375.48
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.86 |
| Max. Negotiated Rate |
$281.61 |
| Rate for Payer: Adventist Health Commercial |
$75.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.29
|
| 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 |
$168.97
|
| Rate for Payer: Cash Price |
$168.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.85
|
| Rate for Payer: Heritage Provider Network Senior |
$173.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$179.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88.25
|
| Rate for Payer: Multiplan Commercial |
$281.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.19
|
| Rate for Payer: TriValley Medical Group Senior |
$150.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$124.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.45
|
| Rate for Payer: Vantage Medical Group Senior |
$72.45
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
|
IP
|
$375.48
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$281.61 |
| Rate for Payer: Adventist Health Commercial |
$75.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.81
|
| Rate for Payer: Cash Price |
$168.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.85
|
| Rate for Payer: Heritage Provider Network Senior |
$173.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.87
|
| Rate for Payer: Multiplan Commercial |
$281.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$124.32
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| 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 |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
|
IP
|
$0.18
|
|
|
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 |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
IP
|
$23.49
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.13
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.88
|
| Rate for Payer: Heritage Provider Network Senior |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$17.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.78
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
|
OP
|
$23.49
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.02
|
| 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 |
$10.57
|
| Rate for Payer: Cash Price |
$10.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.88
|
| Rate for Payer: Heritage Provider Network Senior |
$10.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$17.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.40
|
| Rate for Payer: TriValley Medical Group Senior |
$9.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.89
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
|
OP
|
$14.38
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$12.22 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| 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 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: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.20
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$6.66
|
| Rate for Payer: Heritage Provider Network Senior |
$4.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Multiplan Commercial |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$10.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.63
|
| Rate for Payer: TriValley Medical Group Senior |
$3.63
|
| Rate for Payer: TriValley Medical Group Senior |
$6.24
|
| Rate for Payer: TriValley Medical Group Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| 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+ |
$4.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.72
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
|
IP
|
$9.08
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.26
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.66
|
| 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 |
$6.66
|
| Rate for Payer: Heritage Provider Network Senior |
$4.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$10.79
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION [187493]
|
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: Aetna of CA Non-Gatekeeper |
$10.04
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.16
|
|
|
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 |
$0.52 |
| Max. Negotiated Rate |
$13.25 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Senior |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.24
|
| 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 Navigate/Select/Select+ |
$5.16
|
| 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 Senior |
$13.25
|
|
