|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$238.29
|
| Rate for Payer: Aetna of CA Government/Medicare |
$238.29
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$317.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$238.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$238.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.43
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$238.29
|
| Rate for Payer: Aetna of CA Government/Medicare |
$238.29
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$317.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$238.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$238.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.43
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$317.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$238.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.43
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$925.32
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$740.26 |
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$740.26
|
| Rate for Payer: Health Smart Auto/Commercial |
$555.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.93
|
| Rate for Payer: Multiplan Commercial |
$693.99
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$925.32
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$740.26 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$555.19
|
| Rate for Payer: Aetna of CA Government/Medicare |
$555.19
|
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$740.26
|
| Rate for Payer: Health Smart Auto/Commercial |
$555.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$555.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.93
|
| Rate for Payer: Multiplan Commercial |
$693.99
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$238.29
|
| Rate for Payer: Aetna of CA Government/Medicare |
$238.29
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$317.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$238.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$238.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.43
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$317.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$238.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.43
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$495.76
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.67 |
| Max. Negotiated Rate |
$396.61 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$297.46
|
| Rate for Payer: Aetna of CA Government/Medicare |
$297.46
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$396.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$297.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$297.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.67
|
| Rate for Payer: Multiplan Commercial |
$371.82
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$495.76
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.67 |
| Max. Negotiated Rate |
$396.61 |
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$396.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$297.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.67
|
| Rate for Payer: Multiplan Commercial |
$371.82
|
|
|
NOREPINEPHRINE 40 MCG/10 ML NS SYRINGE FOR ANESTHESIA [40805634]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9994-0856-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
NOREPINEPHRINE 40 MCG/10 ML NS SYRINGE FOR ANESTHESIA [40805634]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9994-0856-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.01
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-14
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-14
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.04
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.04
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 0143-9318-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.59
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.59
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$3.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 63323-940-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 0143-9318-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$3.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$5.41
|
|
|
Service Code
|
NDC 70121-1576-7
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.25
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$4.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 63323-940-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 43066-997-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.90
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 0143-9318-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$3.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 25021-316-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.44
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.92
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 70121-1576-7
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$4.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 63323-940-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
