|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
OP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
IP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
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 |
$1.98
|
| 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 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
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY [16071]
|
Facility
OP
|
$2.88
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
1743744
|
|
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 Gatekeeper |
$1.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| 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 Senior |
$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 Permanente of CA Commercial |
$1.39
|
| 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
|
| 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 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
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 |
$2.01
|
| 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 Permanente of CA 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 24208-399-15
|
| Hospital Charge Code |
1743744
|
|
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 Gatekeeper |
$1.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.71
|
| 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 Senior |
$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 Permanente of CA Commercial |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.48
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
OP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| 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 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: Multiplan Commercial |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
IRBESARTAN 75 MG TABLET [21847]
|
Facility
IP
|
$0.25
|
|
|
Service Code
|
NDC 33342-047-10
|
| Hospital Charge Code |
1711687
|
|
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 |
$0.17
|
| 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 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
|
|
|
Iridotomy by stab incision (separate procedure); except transfixion
|
Facility
OP
|
$5,532.10
|
|
|
Service Code
|
CPT 66500
|
| Min. Negotiated Rate |
$328.72 |
| Max. Negotiated Rate |
$5,532.10 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$328.72
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
IP
|
$9.91
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| 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 |
$6.81
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| 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 |
$6.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$6.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4.88
|
| 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 |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.79
|
| 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 |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.31
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION [91054]
|
Facility
OP
|
$7.21
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$284.65 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Adventist Health Commercial |
$1.63
|
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| 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 |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| 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 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: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Senior |
$6.94
|
| Rate for Payer: Dignity Health Senior |
$6.13
|
| Rate for Payer: Dignity Health Senior |
$8.42
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.59
|
| 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 |
$3.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| 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: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$6.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$8.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION [108138]
|
Facility
OP
|
$9.10
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG108138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$284.65 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| 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 |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Senior |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4.21
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
IRINOTECAN 300 MG/15 ML INTRAVENOUS SOLUTION [108138]
|
Facility
IP
|
$9.10
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG108138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.25
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.16
|
| Rate for Payer: Heritage Provider Network Senior |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
OP
|
$8.40
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$284.65 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Adventist Health Commercial |
$2.06
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| 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 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 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 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: 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: 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: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.76
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$14.09
|
| Rate for Payer: Dignity Health Senior |
$7.74
|
| Rate for Payer: Dignity Health Senior |
$11.02
|
| Rate for Payer: Dignity Health Senior |
$4.59
|
| Rate for Payer: Dignity Health Senior |
$7.74
|
| Rate for Payer: Dignity Health Senior |
$7.28
|
| Rate for Payer: Dignity Health Senior |
$8.76
|
| Rate for Payer: Dignity Health Senior |
$8.16
|
| Rate for Payer: Dignity Health Senior |
$7.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$12.44
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$8.76
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$7.41
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$14.09
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION [91055]
|
Facility
IP
|
$10.30
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
1755603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Adventist Health Commercial |
$2.06
|
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.60
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5.80
|
| Rate for Payer: Heritage Provider Network Senior |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.97
|
| Rate for Payer: Heritage Provider Network Senior |
$11.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.66
|
| Rate for Payer: Heritage Provider Network Senior |
$8.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.16
|
| Rate for Payer: Heritage Provider Network Senior |
$6.17
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Multiplan Commercial |
$12.44
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Multiplan Commercial |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.54
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
OP
|
$7.07
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG94341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$284.65 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.65
|
| 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 |
$3.18
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.01
|
| Rate for Payer: Dignity Health Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Senior |
$3.27
|
| Rate for Payer: IEHP Medi-Cal |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
IRINOTECAN 500 MG/25 ML INTRAVENOUS SOLUTION [94341]
|
Facility
IP
|
$7.07
|
|
|
Service Code
|
CPT J9206
|
| Hospital Charge Code |
NDG94341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.86
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.36
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
IP
|
$323.88
|
|
|
Service Code
|
CPT J9205
|
| Hospital Charge Code |
NDG211718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$242.91 |
| Rate for Payer: Adventist Health Commercial |
$64.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.51
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.27
|
| Rate for Payer: Heritage Provider Network Senior |
$219.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.97
|
| Rate for Payer: Multiplan Commercial |
$242.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$118.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$108.21
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS [211718]
|
Facility
OP
|
$323.88
|
|
|
Service Code
|
CPT J9205
|
| Hospital Charge Code |
NDG211718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$242.91 |
| Rate for Payer: Adventist Health Commercial |
$64.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$122.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$68.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.48
|
| Rate for Payer: Blue Shield of California Commercial |
$61.27
|
| Rate for Payer: Blue Shield of California EPN |
$61.27
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.22
|
| Rate for Payer: Dignity Health Senior |
$68.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.96
|
| Rate for Payer: Heritage Provider Network Senior |
$149.96
|
| Rate for Payer: Humana Medicare |
$62.02
|
| Rate for Payer: IEHP Medi-Cal |
$103.71
|
| Rate for Payer: IEHP Medicare Advantage |
$62.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.15
|
| Rate for Payer: Multiplan Commercial |
$242.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$68.22
|
| Rate for Payer: TriValley Medical Group Senior |
$62.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$118.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$108.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.22
|
| Rate for Payer: Vantage Medical Group Senior |
$62.02
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
1711916
|
|
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 Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
IRON, CARBONYL 45 MG TABLET [33267]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 4601709660
|
| Hospital Charge Code |
1711916
|
|
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 Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
IP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-01
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.74
|
| Rate for Payer: Heritage Provider Network Senior |
$13.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.78
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
OP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-01
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: Dignity Health Senior |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.39
|
| Rate for Payer: Heritage Provider Network Senior |
$9.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
OP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-10
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.25
|
| Rate for Payer: Dignity Health Senior |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.39
|
| Rate for Payer: Heritage Provider Network Senior |
$9.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.25
|
| Rate for Payer: Vantage Medical Group Senior |
$17.25
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION [221652]
|
Facility
IP
|
$20.29
|
|
|
Service Code
|
NDC 0023-6082-10
|
| Hospital Charge Code |
NDG199344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.94
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.74
|
| Rate for Payer: Heritage Provider Network Senior |
$13.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.78
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION [29132]
|
Facility
IP
|
$8.83
|
|
|
Service Code
|
CPT J1756
|
| Hospital Charge Code |
1720948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.98
|
| Rate for Payer: Heritage Provider Network Senior |
$9.38
|
| Rate for Payer: Heritage Provider Network Senior |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.95
|
|
