|
NAPROXEN 250 MG TABLET [5391]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 50268-594-11
|
| Hospital Charge Code |
1711235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Distinction Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
NAPROXEN 250 MG TABLET [5391]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 50268-594-15
|
| Hospital Charge Code |
1711235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Distinction Transplant |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
NAPROXEN 250 MG TABLET [5391]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 50268-594-11
|
| Hospital Charge Code |
1711235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
NAPROXEN 250 MG TABLET [5391]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 50268-594-15
|
| Hospital Charge Code |
1711235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.22
|
| Rate for Payer: Cigna of CA PPO |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
NAPROXEN 250 MG TABLET [5391]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 68462-188-01
|
| Hospital Charge Code |
1711235
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| 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: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| 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 |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
NAPROXEN 375 MG TABLET [5392]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 68462-189-01
|
| Hospital Charge Code |
1711242
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| 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: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| 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
|
|
|
NAPROXEN 375 MG TABLET [5392]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 68462-189-01
|
| Hospital Charge Code |
1711242
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| 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 |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| 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 Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| 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
|
| 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
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 68462-190-01
|
| Hospital Charge Code |
1711246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Distinction Transplant |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Media |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 65162-190-10
|
| Hospital Charge Code |
1711246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Distinction Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 68462-190-01
|
| Hospital Charge Code |
1711246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 65162-190-10
|
| Hospital Charge Code |
1711246
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 31231
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$400.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage
|
Facility
|
OP
|
$7,385.00
|
|
|
Service Code
|
CPT 31238
|
| Min. Negotiated Rate |
$331.06 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed
|
Facility
|
OP
|
$14,024.46
|
|
|
Service Code
|
CPT 31276
|
| Min. Negotiated Rate |
$641.59 |
| Max. Negotiated Rate |
$14,024.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,024.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
Nasal/sinus endoscopy, surgical, with maxillary antrostomy;
|
Facility
|
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 31256
|
| Min. Negotiated Rate |
$321.86 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
Nasal/sinus endoscopy, surgical, with sphenoidotomy;
|
Facility
|
OP
|
$14,024.46
|
|
|
Service Code
|
CPT 31287
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$14,024.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,024.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]
|
Facility
|
IP
|
$656.75
|
|
|
Service Code
|
CPT J2323
|
| Hospital Charge Code |
1720955
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Blue Shield of California Commercial |
$467.61
|
| Rate for Payer: Blue Shield of California EPN |
$336.26
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Cigna of CA HMO |
$459.72
|
| Rate for Payer: Cigna of CA PPO |
$459.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.70
|
| Rate for Payer: Galaxy Health WC |
$558.24
|
| Rate for Payer: Global Benefits Group Commercial |
$394.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.62
|
| Rate for Payer: Multiplan Commercial |
$525.40
|
| Rate for Payer: Networks By Design Commercial |
$328.38
|
| Rate for Payer: Prime Health Services Commercial |
$558.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.99
|
| Rate for Payer: United Healthcare All Other HMO |
$242.21
|
| Rate for Payer: United Healthcare HMO Rider |
$236.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.73
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]
|
Facility
|
OP
|
$656.75
|
|
|
Service Code
|
CPT J2323
|
| Hospital Charge Code |
1720955
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$153.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.16
|
| Rate for Payer: Blue Distinction Transplant |
$394.05
|
| Rate for Payer: Blue Shield of California Commercial |
$484.02
|
| Rate for Payer: Blue Shield of California EPN |
$28.37
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Cigna of CA HMO |
$459.72
|
| Rate for Payer: Cigna of CA PPO |
$459.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.68
|
| Rate for Payer: Dignity Health Media |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.45
|
| Rate for Payer: Galaxy Health WC |
$558.24
|
| Rate for Payer: Global Benefits Group Commercial |
$394.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$492.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$40.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$39.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.77
|
| Rate for Payer: Multiplan Commercial |
$525.40
|
| Rate for Payer: Networks By Design Commercial |
$328.38
|
| Rate for Payer: Prime Health Services Commercial |
$558.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.38
|
| Rate for Payer: United Healthcare All Other HMO |
$328.38
|
| Rate for Payer: United Healthcare HMO Rider |
$328.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$24.45
|
|
|
NATAMYCIN 5 % EYE DROPS,SUSPENSION [10692]
|
Facility
|
IP
|
$37.89
|
|
|
Service Code
|
NDC 0065-0645-15
|
| Hospital Charge Code |
1740103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: Blue Shield of California Commercial |
$26.98
|
| Rate for Payer: Blue Shield of California EPN |
$19.40
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$26.52
|
| Rate for Payer: Cigna of CA PPO |
$26.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.16
|
| Rate for Payer: Galaxy Health WC |
$32.21
|
| Rate for Payer: Global Benefits Group Commercial |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$30.31
|
| Rate for Payer: Networks By Design Commercial |
$24.63
|
| Rate for Payer: Prime Health Services Commercial |
$32.21
|
|
|
NATAMYCIN 5 % EYE DROPS,SUSPENSION [10692]
|
Facility
|
OP
|
$37.89
|
|
|
Service Code
|
NDC 71776-005-15
|
| Hospital Charge Code |
1740103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.57
|
| Rate for Payer: Blue Distinction Transplant |
$22.73
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$22.13
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$26.52
|
| Rate for Payer: Cigna of CA PPO |
$26.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.21
|
| Rate for Payer: Dignity Health Media |
$32.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.16
|
| Rate for Payer: Galaxy Health WC |
$32.21
|
| Rate for Payer: Global Benefits Group Commercial |
$22.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$30.31
|
| Rate for Payer: Networks By Design Commercial |
$24.63
|
| Rate for Payer: Prime Health Services Commercial |
$32.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.94
|
| Rate for Payer: United Healthcare All Other HMO |
$18.94
|
| Rate for Payer: United Healthcare HMO Rider |
$18.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$32.21
|
|
|
NATAMYCIN 5 % EYE DROPS,SUSPENSION [10692]
|
Facility
|
IP
|
$37.89
|
|
|
Service Code
|
NDC 71776-005-15
|
| Hospital Charge Code |
1740103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: Blue Shield of California Commercial |
$26.98
|
| Rate for Payer: Blue Shield of California EPN |
$19.40
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$26.52
|
| Rate for Payer: Cigna of CA PPO |
$26.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.16
|
| Rate for Payer: Galaxy Health WC |
$32.21
|
| Rate for Payer: Global Benefits Group Commercial |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$30.31
|
| Rate for Payer: Networks By Design Commercial |
$24.63
|
| Rate for Payer: Prime Health Services Commercial |
$32.21
|
|
|
NATAMYCIN 5 % EYE DROPS,SUSPENSION [10692]
|
Facility
|
OP
|
$37.89
|
|
|
Service Code
|
NDC 0065-0645-15
|
| Hospital Charge Code |
1740103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.57
|
| Rate for Payer: Blue Distinction Transplant |
$22.73
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$22.13
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$26.52
|
| Rate for Payer: Cigna of CA PPO |
$26.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.21
|
| Rate for Payer: Dignity Health Media |
$32.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.16
|
| Rate for Payer: Galaxy Health WC |
$32.21
|
| Rate for Payer: Global Benefits Group Commercial |
$22.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$30.31
|
| Rate for Payer: Networks By Design Commercial |
$24.63
|
| Rate for Payer: Prime Health Services Commercial |
$32.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.94
|
| Rate for Payer: United Healthcare All Other HMO |
$18.94
|
| Rate for Payer: United Healthcare HMO Rider |
$18.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$32.21
|
|
|
NATEGLINIDE 120 MG TABLET [29438]
|
Facility
|
IP
|
$2.39
|
|
|
Service Code
|
NDC 68084-459-11
|
| Hospital Charge Code |
1711806
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
|
|
NATEGLINIDE 120 MG TABLET [29438]
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
NDC 68084-459-11
|
| Hospital Charge Code |
1711806
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Blue Distinction Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.03
|
| Rate for Payer: Dignity Health Media |
$2.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2.03
|
|
|
NATEGLINIDE 120 MG TABLET [29438]
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
NDC 68084-459-21
|
| Hospital Charge Code |
1711806
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: Blue Distinction Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.03
|
| Rate for Payer: Dignity Health Media |
$2.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2.03
|
|
