|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
NDC 0378911216
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 4359843635
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 6846263945
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 6846263925
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| 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 |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 6846263945
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| 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 |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 4359843611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 6846263925
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 4359843635
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 4359843611
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.87
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.66
|
| Rate for Payer: Prime Health Services Commercial |
$0.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.87
|
| Rate for Payer: Vantage Medical Group Senior |
$0.87
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH [27475]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
NDC 4973011330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.79
|
| Rate for Payer: Cigna of CA PPO |
$0.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Senior |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.96
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.96
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH [27475]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
NDC 4973011330
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.73
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cigna of CA HMO |
$0.79
|
| Rate for Payer: Cigna of CA PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: EPIC Health Plan Senior |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.96
|
| Rate for Payer: Global Benefits Group Commercial |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Other HMO |
$0.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.96
|
| Rate for Payer: Vantage Medical Group Senior |
$0.96
|
|
|
NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [14895]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NITROGLYCERIN 100 MG/250 ML (400 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [14895]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.10
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
|
|
NITROGLYCERIN 10 MG/50 ML D5.2NS SYRINGE [4080694]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| 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: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| 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 |
$0.44
|
| 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 |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| 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
|
|
|
NITROGLYCERIN 10 MG/50 ML D5.2NS SYRINGE [4080694]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| 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 |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.52
|
| 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 |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
|
|
NITROGLYCERIN 25 MG/250 ML (100 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [15858]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA 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 Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
NITROGLYCERIN 25 MG/250 ML (100 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [15858]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 0281032608
|
| 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 |
$1.87
|
| Rate for Payer: Cash Price |
$1.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| 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 [5606]
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 0281032608
|
| 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 |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| 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 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 0281032630
|
| 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: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 0281032630
|
| 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 |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.89
|
| 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
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 0281032608
|
| 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 |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$2.04
|
| Rate for Payer: Cigna of CA PPO |
$2.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| 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 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 0281032608
|
| 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 |
$1.87
|
| Rate for Payer: Cash Price |
$1.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.72
|
| 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 400 MCG/SPRAY TRANSLINGUAL AEROSOL [103879]
|
Facility
|
IP
|
$88.42
|
|
|
Service Code
|
NDC 7629943004
|
| 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 |
$44.83
|
| Rate for Payer: Blue Shield of California Commercial |
$67.99
|
| Rate for Payer: Cash Price |
$39.79
|
| Rate for Payer: Cigna of CA HMO |
$61.89
|
| Rate for Payer: Cigna of CA PPO |
$61.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$56.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.17
|
| 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 400 MCG/SPRAY TRANSLINGUAL AEROSOL [103879]
|
Facility
|
OP
|
$88.42
|
|
|
Service Code
|
NDC 7629943004
|
| 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 |
$56.74
|
| Rate for Payer: Cash Price |
$39.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$56.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.17
|
| 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
|
|
