|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [108955]
|
Facility
|
IP
|
$1,003.82
|
|
|
Service Code
|
CPT J9228
|
| Hospital Charge Code |
1755778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.69 |
| Max. Negotiated Rate |
$752.86 |
| Rate for Payer: Adventist Health Commercial |
$200.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$689.62
|
| Rate for Payer: Cash Price |
$451.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.59
|
| Rate for Payer: Heritage Provider Network Senior |
$679.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.96
|
| Rate for Payer: Multiplan Commercial |
$752.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$365.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.38
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [108955]
|
Facility
|
OP
|
$1,003.82
|
|
|
Service Code
|
CPT J9228
|
| Hospital Charge Code |
1755778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.02 |
| Max. Negotiated Rate |
$752.86 |
| Rate for Payer: Adventist Health Commercial |
$200.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$423.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$689.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.39
|
| Rate for Payer: Blue Shield of California Commercial |
$164.02
|
| Rate for Payer: Blue Shield of California EPN |
$164.02
|
| Rate for Payer: Cash Price |
$451.72
|
| Rate for Payer: Cash Price |
$451.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.66
|
| Rate for Payer: Dignity Health Senior |
$189.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$172.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.77
|
| Rate for Payer: Heritage Provider Network Senior |
$464.77
|
| Rate for Payer: Humana Medicare |
$172.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$275.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.25
|
| Rate for Payer: Multiplan Commercial |
$752.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$401.53
|
| Rate for Payer: TriValley Medical Group Senior |
$401.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$365.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$258.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.66
|
| Rate for Payer: Vantage Medical Group Senior |
$172.42
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-83
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 0487-0201-01
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.82
|
| Rate for Payer: Dignity Health Senior |
$0.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Senior |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.38
|
| Rate for Payer: TriValley Medical Group Senior |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.82
|
| Rate for Payer: Vantage Medical Group Senior |
$0.82
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-83
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| 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 |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 0487-0201-01
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.66
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Senior |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 0378-9671-93
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-79
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 76204-600-01
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 0378-9671-93
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Senior |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| 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 Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Senior |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 76204-600-01
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| 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 |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN [30510]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 60687-405-79
|
| Hospital Charge Code |
1744130
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| 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 |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [207748]
|
Facility
|
IP
|
$142.53
|
|
|
Service Code
|
NDC 0597-0024-02
|
| Hospital Charge Code |
NDG196679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$106.90 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.92
|
| Rate for Payer: Cash Price |
$64.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.49
|
| Rate for Payer: Heritage Provider Network Senior |
$96.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.63
|
| Rate for Payer: Multiplan Commercial |
$106.90
|
|
|
IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION [207748]
|
Facility
|
OP
|
$142.53
|
|
|
Service Code
|
NDC 0597-0024-02
|
| Hospital Charge Code |
NDG196679
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$121.15 |
| Rate for Payer: Adventist Health Commercial |
$28.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.90
|
| Rate for Payer: Blue Shield of California Commercial |
$88.51
|
| Rate for Payer: Blue Shield of California EPN |
$83.67
|
| Rate for Payer: Cash Price |
$64.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.15
|
| Rate for Payer: Dignity Health Senior |
$121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.23
|
| Rate for Payer: Heritage Provider Network Senior |
$88.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.63
|
| Rate for Payer: Multiplan Commercial |
$106.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.01
|
| Rate for Payer: TriValley Medical Group Senior |
$57.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$121.15
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-83
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.11
|
| Rate for Payer: Dignity Health Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.11
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 76204-100-30
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-79
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Senior |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 60687-394-83
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Senior |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION [12580]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0487-9801-01
|
| Hospital Charge Code |
1781098
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
IP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$31.97 |
| Rate for Payer: Adventist Health Commercial |
$8.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.29
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.86
|
| Rate for Payer: Heritage Provider Network Senior |
$28.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$31.97
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER [41142]
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
1744132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Adventist Health Commercial |
$8.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.97
|
| Rate for Payer: Blue Shield of California Commercial |
$26.47
|
| Rate for Payer: Blue Shield of California EPN |
$25.02
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.24
|
| Rate for Payer: Dignity Health Senior |
$36.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.39
|
| Rate for Payer: Heritage Provider Network Senior |
$26.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$31.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.05
|
| Rate for Payer: TriValley Medical Group Senior |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.24
|
| Rate for Payer: Vantage Medical Group Senior |
$36.24
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY [16070]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
1743715
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| 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 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
|
|
