|
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: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$3,435.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$13,853.43
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$7,579.87
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$13,853.43
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$13,853.43
|
| Rate for Payer: 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
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: AlphaCare Medical Group Commercial/Exchange |
$30.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.16
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$492.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$40.10
|
| Rate for Payer: IEHP Medi-Cal |
$39.61
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$39.61
|
| Rate for Payer: 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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$32.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.57
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$22.73
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$32.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.57
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$22.73
|
| 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 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
|
|
|
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 68084-459-21
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.43
|
| 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
IP
|
$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: 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: AlphaCare Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.42
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.43
|
| 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 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: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| 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: 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: AlphaCare Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.35
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1.36
|
| 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$762.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$670.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$670.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,123.31
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$987.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$987.82
|
| Rate for Payer: 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: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.34
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.15
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$4.18
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2.03
|
| 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
|
|
