|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 0281-0326-08
|
| Hospital Charge Code |
1743605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.99
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 0281-0326-08
|
| Hospital Charge Code |
1743605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.59
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.59
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.99
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX4080670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.11
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX4080670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
CPT J2305
|
| Hospital Charge Code |
1757264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.28
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
CPT J2305
|
| Hospital Charge Code |
1757264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.28
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.66
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.53
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.66
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$293.53 |
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.53
|
| Rate for Payer: Health Smart Auto/Commercial |
$220.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$275.18
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$220.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$220.15
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$220.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$275.18
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$220.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$220.15
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$220.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$275.18
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$293.53 |
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.53
|
| Rate for Payer: Health Smart Auto/Commercial |
$220.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$275.18
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$470.17 |
| Max. Negotiated Rate |
$683.88 |
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$683.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$512.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$641.14
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$470.17 |
| Max. Negotiated Rate |
$641.14 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$512.91
|
| Rate for Payer: Aetna of CA Government/Medicare |
$512.91
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$512.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$512.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$641.14
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$293.53 |
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.53
|
| Rate for Payer: Health Smart Auto/Commercial |
$220.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$275.18
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$220.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$220.15
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$220.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$275.18
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$322.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$257.69
|
| Rate for Payer: Aetna of CA Government/Medicare |
$257.69
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$257.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$257.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.22
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$322.12
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$343.59 |
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.59
|
| Rate for Payer: Health Smart Auto/Commercial |
$257.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.22
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$322.12
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 70121-1576-1
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS |
$4.06
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
NDC 63323-940-21
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.36
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.24
|
|
|
Service Code
|
NDC 67457-852-00
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.93
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 25021-316-04
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.57
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.57
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.96
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
NDC 63323-940-21
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.89
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.89
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.36
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-14
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS |
$5.06
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
1720130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$5.06 |
| 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 |
$3.03
|
| 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 Beech St/Commercial/PHCS |
$5.06
|
|
