|
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 60 MG TABLET [29437]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 68084-458-11
|
| Hospital Charge Code |
1711805
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
NATEGLINIDE 60 MG TABLET [29437]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 68084-458-11
|
| Hospital Charge Code |
1711805
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: Blue Distinction Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Media |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.93
|
|
|
NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]
|
Facility
|
IP
|
$2,770.88
|
|
|
Service Code
|
CPT J9348
|
| Hospital Charge Code |
NDG229812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$665.01 |
| Max. Negotiated Rate |
$2,355.25 |
| Rate for Payer: Blue Shield of California Commercial |
$1,972.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,418.69
|
| Rate for Payer: Cash Price |
$1,246.90
|
| Rate for Payer: Cigna of CA HMO |
$1,939.62
|
| Rate for Payer: Cigna of CA PPO |
$1,939.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,108.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,108.35
|
| Rate for Payer: Galaxy Health WC |
$2,355.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,055.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.01
|
| Rate for Payer: Multiplan Commercial |
$2,216.70
|
| Rate for Payer: Networks By Design Commercial |
$1,385.44
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,046.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,021.90
|
| Rate for Payer: United Healthcare HMO Rider |
$999.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$914.39
|
|
|
NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]
|
Facility
|
OP
|
$2,770.88
|
|
|
Service Code
|
CPT J9348
|
| Hospital Charge Code |
NDG229812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.76 |
| Max. Negotiated Rate |
$3,835.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,835.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$670.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$670.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,123.31
|
| Rate for Payer: Blue Distinction Transplant |
$1,662.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,042.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,618.19
|
| Rate for Payer: Cash Price |
$1,246.90
|
| Rate for Payer: Cash Price |
$1,246.90
|
| Rate for Payer: Cigna of CA HMO |
$1,939.62
|
| Rate for Payer: Cigna of CA PPO |
$1,939.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.21
|
| Rate for Payer: Dignity Health Media |
$670.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$670.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$823.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$609.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$609.76
|
| Rate for Payer: Galaxy Health WC |
$2,355.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,662.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,078.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,000.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,000.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$987.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$987.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$609.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,167.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$768.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$817.09
|
| Rate for Payer: Multiplan Commercial |
$2,216.70
|
| Rate for Payer: Networks By Design Commercial |
$1,385.44
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,662.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,662.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,385.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,385.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,385.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,385.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$670.74
|
| Rate for Payer: Vantage Medical Group Senior |
$670.74
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 67877-391-30
|
| Hospital Charge Code |
1712399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 67877-391-30
|
| Hospital Charge Code |
1712399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 43547-526-03
|
| Hospital Charge Code |
1712399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 43547-526-03
|
| Hospital Charge Code |
1712399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Distinction Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$6.96
|
|
|
Service Code
|
NDC 0456-1405-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Blue Shield of California Commercial |
$4.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.56
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 67877-392-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 62559-276-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: Blue Distinction Transplant |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Media |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$6.96
|
|
|
Service Code
|
NDC 0456-1405-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.15
|
| Rate for Payer: Blue Distinction Transplant |
$4.18
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.06
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Media |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 43547-525-03
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Distinction Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 67877-392-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 62559-276-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 43547-525-03
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]
|
Facility
|
OP
|
$15.86
|
|
|
Service Code
|
CPT J9261
|
| Hospital Charge Code |
1755714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.66
|
| Rate for Payer: Blue Distinction Transplant |
$9.52
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California EPN |
$176.49
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.47
|
| Rate for Payer: Dignity Health Media |
$110.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$110.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$110.98
|
| Rate for Payer: Galaxy Health WC |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$182.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$179.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$110.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.72
|
| Rate for Payer: Multiplan Commercial |
$12.69
|
| Rate for Payer: Networks By Design Commercial |
$7.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7.93
|
| Rate for Payer: United Healthcare HMO Rider |
$7.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.08
|
| Rate for Payer: Vantage Medical Group Senior |
$110.98
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]
|
Facility
|
IP
|
$15.86
|
|
|
Service Code
|
CPT J9261
|
| Hospital Charge Code |
1755714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$8.12
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.34
|
| Rate for Payer: Galaxy Health WC |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$12.69
|
| Rate for Payer: Networks By Design Commercial |
$7.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO |
$5.85
|
| Rate for Payer: United Healthcare HMO Rider |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.23
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 63010-010-30
|
| Hospital Charge Code |
1712238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.90
|
| Rate for Payer: Blue Distinction Transplant |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Media |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 63010-010-30
|
| Hospital Charge Code |
1712238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0713-0622-31
|
| Hospital Charge Code |
NDG21070C
|
|
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
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0713-0622-31
|
| Hospital Charge Code |
NDG21070C
|
|
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
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
|
OP
|
$6.13
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
1740124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.65
|
| Rate for Payer: Blue Distinction Transplant |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.52
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Media |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
|
IP
|
$6.13
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
1740124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Blue Shield of California Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
|
