|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 0281-0326-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Senior |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.27
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.27
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 0281-0326-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$2.33
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$2.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1.46
|
| Rate for Payer: United Healthcare HMO Rider |
$1.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2.47
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 0281-0326-08
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Adventist Health Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.41
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.16
|
| Rate for Payer: Galaxy Health WC |
$2.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.33
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$2.47
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL AEROSOL [103879]
|
Facility
|
OP
|
$88.42
|
|
|
Service Code
|
NDC 76299-430-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Adventist Health Commercial |
$17.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.30
|
| Rate for Payer: Cash Price |
$48.63
|
| Rate for Payer: Cigna of CA HMO |
$61.89
|
| Rate for Payer: Cigna of CA PPO |
$61.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.37
|
| Rate for Payer: Galaxy Health WC |
$75.16
|
| Rate for Payer: Global Benefits Group Commercial |
$53.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.89
|
| Rate for Payer: Multiplan Commercial |
$70.74
|
| Rate for Payer: Networks By Design Commercial |
$57.47
|
| Rate for Payer: Prime Health Services Commercial |
$75.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.21
|
| Rate for Payer: United Healthcare All Other HMO |
$44.21
|
| Rate for Payer: United Healthcare HMO Rider |
$44.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.16
|
| Rate for Payer: Vantage Medical Group Senior |
$75.16
|
|
|
NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL AEROSOL [103879]
|
Facility
|
IP
|
$88.42
|
|
|
Service Code
|
NDC 76299-430-04
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Adventist Health Commercial |
$17.68
|
| Rate for Payer: Blue Shield of California Commercial |
$65.25
|
| Rate for Payer: Blue Shield of California EPN |
$42.97
|
| Rate for Payer: Cash Price |
$48.63
|
| Rate for Payer: Cigna of CA HMO |
$61.89
|
| Rate for Payer: Cigna of CA PPO |
$61.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.37
|
| Rate for Payer: Galaxy Health WC |
$75.16
|
| Rate for Payer: Global Benefits Group Commercial |
$53.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$70.74
|
| Rate for Payer: Networks By Design Commercial |
$57.47
|
| Rate for Payer: Prime Health Services Commercial |
$75.16
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
OP
|
$1.87
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Senior |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.59
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
IP
|
$1.87
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.75
|
| Rate for Payer: EPIC Health Plan Senior |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$1.59
|
| Rate for Payer: Global Benefits Group Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.61
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Senior |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
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 |
$32.35 |
| Max. Negotiated Rate |
$337.58 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.15
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Blue Shield of California EPN |
$38.17
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO |
$278.00
|
| Rate for Payer: Cigna of CA PPO |
$278.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.55
|
| Rate for Payer: EPIC Health Plan Senior |
$33.00
|
| Rate for Payer: Galaxy Health WC |
$337.58
|
| Rate for Payer: Global Benefits Group Commercial |
$238.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.22
|
| Rate for Payer: Multiplan Commercial |
$317.72
|
| Rate for Payer: Networks By Design Commercial |
$198.57
|
| Rate for Payer: Prime Health Services Commercial |
$337.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.08
|
| Rate for Payer: United Healthcare HMO Rider |
$141.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Vantage Medical Group Senior |
$36.30
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$337.58 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Blue Shield of California Commercial |
$293.10
|
| Rate for Payer: Blue Shield of California EPN |
$193.01
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO |
$278.00
|
| Rate for Payer: Cigna of CA PPO |
$278.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.86
|
| Rate for Payer: EPIC Health Plan Senior |
$158.86
|
| Rate for Payer: Galaxy Health WC |
$337.58
|
| Rate for Payer: Global Benefits Group Commercial |
$238.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.32
|
| Rate for Payer: Multiplan Commercial |
$317.72
|
| Rate for Payer: Networks By Design Commercial |
$198.57
|
| Rate for Payer: Prime Health Services Commercial |
$337.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.08
|
| Rate for Payer: United Healthcare HMO Rider |
$141.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.07
|
|
|
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 |
$32.35 |
| Max. Negotiated Rate |
$337.58 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.15
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Blue Shield of California EPN |
$38.17
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO |
$278.00
|
| Rate for Payer: Cigna of CA PPO |
$278.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.55
|
| Rate for Payer: EPIC Health Plan Senior |
$33.00
|
| Rate for Payer: Galaxy Health WC |
$337.58
|
| Rate for Payer: Global Benefits Group Commercial |
$238.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.22
|
| Rate for Payer: Multiplan Commercial |
$317.72
|
| Rate for Payer: Networks By Design Commercial |
$198.57
|
| Rate for Payer: Prime Health Services Commercial |
$337.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.08
|
| Rate for Payer: United Healthcare HMO Rider |
$141.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Vantage Medical Group Senior |
$36.30
|
|
|
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 |
$79.43 |
| Max. Negotiated Rate |
$337.58 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Blue Shield of California Commercial |
$293.10
|
| Rate for Payer: Blue Shield of California EPN |
$193.01
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO |
$278.00
|
| Rate for Payer: Cigna of CA PPO |
$278.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.86
|
| Rate for Payer: EPIC Health Plan Senior |
$158.86
|
| Rate for Payer: Galaxy Health WC |
$337.58
|
| Rate for Payer: Global Benefits Group Commercial |
$238.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.32
|
| Rate for Payer: Multiplan Commercial |
$317.72
|
| Rate for Payer: Networks By Design Commercial |
$198.57
|
| Rate for Payer: Prime Health Services Commercial |
$337.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.08
|
| Rate for Payer: United Healthcare HMO Rider |
$141.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.07
|
|
|
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 |
$185.06 |
| Max. Negotiated Rate |
$786.52 |
| Rate for Payer: Adventist Health Commercial |
$185.06
|
| Rate for Payer: Blue Shield of California Commercial |
$682.89
|
| Rate for Payer: Blue Shield of California EPN |
$449.71
|
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Cigna of CA HMO |
$647.72
|
| Rate for Payer: Cigna of CA PPO |
$647.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.13
|
| Rate for Payer: EPIC Health Plan Senior |
$370.13
|
| Rate for Payer: Galaxy Health WC |
$786.52
|
| Rate for Payer: Global Benefits Group Commercial |
$555.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.08
|
| Rate for Payer: Multiplan Commercial |
$740.26
|
| Rate for Payer: Networks By Design Commercial |
$462.66
|
| Rate for Payer: Prime Health Services Commercial |
$786.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$347.27
|
| Rate for Payer: United Healthcare All Other HMO |
$338.02
|
| Rate for Payer: United Healthcare HMO Rider |
$330.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.04
|
|
|
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 |
$185.06 |
| Max. Negotiated Rate |
$786.52 |
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Adventist Health Commercial |
$185.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.38
|
| Rate for Payer: Blue Shield of California Commercial |
$222.35
|
| Rate for Payer: Blue Shield of California EPN |
$222.35
|
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Cigna of CA HMO |
$647.72
|
| Rate for Payer: Cigna of CA PPO |
$647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.82
|
| Rate for Payer: EPIC Health Plan Senior |
$197.65
|
| Rate for Payer: Galaxy Health WC |
$786.52
|
| Rate for Payer: Global Benefits Group Commercial |
$555.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$197.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.85
|
| Rate for Payer: Multiplan Commercial |
$740.26
|
| Rate for Payer: Networks By Design Commercial |
$462.66
|
| Rate for Payer: Prime Health Services Commercial |
$786.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$347.27
|
| Rate for Payer: United Healthcare All Other HMO |
$338.02
|
| Rate for Payer: United Healthcare HMO Rider |
$330.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$197.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.41
|
| Rate for Payer: Vantage Medical Group Senior |
$217.41
|
|
|
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 |
$32.35 |
| Max. Negotiated Rate |
$337.58 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.15
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Blue Shield of California EPN |
$38.17
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO |
$278.00
|
| Rate for Payer: Cigna of CA PPO |
$278.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.55
|
| Rate for Payer: EPIC Health Plan Senior |
$33.00
|
| Rate for Payer: Galaxy Health WC |
$337.58
|
| Rate for Payer: Global Benefits Group Commercial |
$238.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.22
|
| Rate for Payer: Multiplan Commercial |
$317.72
|
| Rate for Payer: Networks By Design Commercial |
$198.57
|
| Rate for Payer: Prime Health Services Commercial |
$337.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.08
|
| Rate for Payer: United Healthcare HMO Rider |
$141.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Vantage Medical Group Senior |
$36.30
|
|
|
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 |
$79.43 |
| Max. Negotiated Rate |
$337.58 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Blue Shield of California Commercial |
$293.10
|
| Rate for Payer: Blue Shield of California EPN |
$193.01
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO |
$278.00
|
| Rate for Payer: Cigna of CA PPO |
$278.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.86
|
| Rate for Payer: EPIC Health Plan Senior |
$158.86
|
| Rate for Payer: Galaxy Health WC |
$337.58
|
| Rate for Payer: Global Benefits Group Commercial |
$238.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.32
|
| Rate for Payer: Multiplan Commercial |
$317.72
|
| Rate for Payer: Networks By Design Commercial |
$198.57
|
| Rate for Payer: Prime Health Services Commercial |
$337.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.08
|
| Rate for Payer: United Healthcare HMO Rider |
$141.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.07
|
|
|
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 |
$99.15 |
| Max. Negotiated Rate |
$421.40 |
| Rate for Payer: Adventist Health Commercial |
$99.15
|
| Rate for Payer: Blue Shield of California Commercial |
$365.87
|
| Rate for Payer: Blue Shield of California EPN |
$240.94
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Cigna of CA HMO |
$347.03
|
| Rate for Payer: Cigna of CA PPO |
$347.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.30
|
| Rate for Payer: EPIC Health Plan Senior |
$198.30
|
| Rate for Payer: Galaxy Health WC |
$421.40
|
| Rate for Payer: Global Benefits Group Commercial |
$297.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.98
|
| Rate for Payer: Multiplan Commercial |
$396.61
|
| Rate for Payer: Networks By Design Commercial |
$247.88
|
| Rate for Payer: Prime Health Services Commercial |
$421.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$186.06
|
| Rate for Payer: United Healthcare All Other HMO |
$181.10
|
| Rate for Payer: United Healthcare HMO Rider |
$177.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.36
|
|
|
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 |
$99.15 |
| Max. Negotiated Rate |
$562.82 |
| Rate for Payer: Adventist Health Commercial |
$99.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$325.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$371.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.82
|
| Rate for Payer: Blue Shield of California Commercial |
$228.16
|
| Rate for Payer: Blue Shield of California EPN |
$228.16
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Cigna of CA HMO |
$347.03
|
| Rate for Payer: Cigna of CA PPO |
$347.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.30
|
| Rate for Payer: EPIC Health Plan Senior |
$198.30
|
| Rate for Payer: Galaxy Health WC |
$421.40
|
| Rate for Payer: Global Benefits Group Commercial |
$297.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$347.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$347.03
|
| Rate for Payer: Multiplan Commercial |
$396.61
|
| Rate for Payer: Networks By Design Commercial |
$247.88
|
| Rate for Payer: Prime Health Services Commercial |
$421.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$297.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$297.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$186.06
|
| Rate for Payer: United Healthcare All Other HMO |
$181.10
|
| Rate for Payer: United Healthcare HMO Rider |
$177.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$421.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$421.40
|
| Rate for Payer: Vantage Medical Group Senior |
$421.40
|
|
|
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
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
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
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 63323-940-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 70121-1576-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.33
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
|
