|
Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| 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/Senior |
$14,024.46
|
| Rate for Payer: IEHP medi-cal |
$14,109.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Innovage PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health MISP |
$9,406.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,755.97 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| 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/Senior |
$14,024.46
|
| Rate for Payer: IEHP medi-cal |
$14,109.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Innovage PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health MISP |
$9,406.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 frontal sinus exploration, including removal of tissue from frontal sinus, when performed
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| 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/Senior |
$14,024.46
|
| Rate for Payer: IEHP medi-cal |
$14,109.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Innovage PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health MISP |
$9,406.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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
|
$15,354.00
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,678.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,678.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| 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/Senior |
$7,673.45
|
| Rate for Payer: IEHP medi-cal |
$7,720.23
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Innovage PACE Commercial |
$7,018.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,269.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Prime Health Services Medicare |
$4,959.67
|
| Rate for Payer: Riverside University Health MISP |
$5,146.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 maxillary antrostomy; with removal of tissue from maxillary sinus
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| 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/Senior |
$14,024.46
|
| Rate for Payer: IEHP medi-cal |
$14,109.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Innovage PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health MISP |
$9,406.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 sphenoidotomy;
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 31287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| 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/Senior |
$14,024.46
|
| Rate for Payer: IEHP medi-cal |
$14,109.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Innovage PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health MISP |
$9,406.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 sphenoidotomy; with removal of tissue from the sphenoid sinus
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 31288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,691.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| 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/Senior |
$14,024.46
|
| Rate for Payer: IEHP medi-cal |
$14,109.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Innovage PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: Preferred Health Network WC |
$11,929.71
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Prime Health Services WC |
$11,571.82
|
| Rate for Payer: Riverside University Health MISP |
$9,406.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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
|
|
|
Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral
|
Facility
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 69705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: IEHP medi-cal |
$12,072.88
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Innovage PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
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 |
$131.35 |
| Max. Negotiated Rate |
$591.08 |
| Rate for Payer: Blue Shield of California Commercial |
$492.56
|
| Rate for Payer: Blue Shield of California EPN |
$350.70
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Central Health Plan Commercial |
$525.40
|
| 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: Health Management Network EPO/PPO |
$591.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.35
|
| Rate for Payer: Multiplan Commercial |
$492.56
|
| Rate for Payer: Networks By Design Commercial |
$328.38
|
| Rate for Payer: Prime Health Services Commercial |
$558.24
|
|
|
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 |
$15.01 |
| Max. Negotiated Rate |
$591.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.55
|
| 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 Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.43
|
| Rate for Payer: BCBS Transplant Transplant |
$394.05
|
| Rate for Payer: Blue Shield of California Commercial |
$31.21
|
| Rate for Payer: Blue Shield of California EPN |
$28.37
|
| Rate for Payer: Caremore Medicare Advantage |
$24.45
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Central Health Plan Commercial |
$525.40
|
| 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: 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 Management Network EPO/PPO |
$591.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$492.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.10
|
| Rate for Payer: IEHP medi-cal |
$40.35
|
| Rate for Payer: IEHP Medicare Advantage |
$24.45
|
| Rate for Payer: Innovage PACE Commercial |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.77
|
| Rate for Payer: Multiplan Commercial |
$492.56
|
| Rate for Payer: Networks By Design Commercial |
$328.38
|
| Rate for Payer: Prime Health Services Commercial |
$558.24
|
| Rate for Payer: Prime Health Services Medicare |
$25.92
|
| Rate for Payer: Riverside University Health MISP |
$26.90
|
| 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
OP
|
$37.89
|
|
|
Service Code
|
NDC 71776-005-15
|
| Hospital Charge Code |
1740103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$34.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.01
|
| 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 Exchange |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.39
|
| Rate for Payer: BCBS Transplant Transplant |
$22.73
|
| Rate for Payer: Blue Shield of California Commercial |
$23.83
|
| Rate for Payer: Blue Shield of California EPN |
$18.53
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$30.31
|
| 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: 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 Management Network EPO/PPO |
$34.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.42
|
| Rate for Payer: IEHP medi-cal |
$13.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| 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: Riverside University Health MISP |
$15.16
|
| 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 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 |
$7.58 |
| Max. Negotiated Rate |
$34.10 |
| Rate for Payer: Blue Shield of California Commercial |
$28.42
|
| Rate for Payer: Blue Shield of California EPN |
$20.23
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$30.31
|
| 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: Health Management Network EPO/PPO |
$34.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| 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 |
$7.58 |
| Max. Negotiated Rate |
$34.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.01
|
| 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 Exchange |
$18.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.39
|
| Rate for Payer: BCBS Transplant Transplant |
$22.73
|
| Rate for Payer: Blue Shield of California Commercial |
$23.83
|
| Rate for Payer: Blue Shield of California EPN |
$18.53
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$30.31
|
| 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: 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 Management Network EPO/PPO |
$34.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.42
|
| Rate for Payer: IEHP medi-cal |
$13.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| 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: Riverside University Health MISP |
$15.16
|
| 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 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 |
$7.58 |
| Max. Negotiated Rate |
$34.10 |
| Rate for Payer: Blue Shield of California Commercial |
$28.42
|
| Rate for Payer: Blue Shield of California EPN |
$20.23
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Central Health Plan Commercial |
$30.31
|
| 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: Health Management Network EPO/PPO |
$34.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$28.42
|
| 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 |
$0.48 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.91
|
| 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: Health Management Network EPO/PPO |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$0.48 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Blue Shield of California Commercial |
$1.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.91
|
| 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: Health Management Network EPO/PPO |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| 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 |
$0.48 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.45
|
| 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 Exchange |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.91
|
| 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: 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 Management Network EPO/PPO |
$2.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.79
|
| Rate for Payer: IEHP medi-cal |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| 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: Riverside University Health MISP |
$0.96
|
| 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 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 |
$0.48 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.45
|
| 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 Exchange |
$1.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: BCBS Transplant Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.91
|
| 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: 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 Management Network EPO/PPO |
$2.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.79
|
| Rate for Payer: IEHP medi-cal |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.79
|
| 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: Riverside University Health MISP |
$0.96
|
| 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 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 |
$0.45 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| 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: Health Management Network EPO/PPO |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| 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 |
$0.45 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| 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 Exchange |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: BCBS Transplant Transplant |
$1.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| 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: 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 Management Network EPO/PPO |
$2.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.70
|
| Rate for Payer: IEHP medi-cal |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| 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: Riverside University Health MISP |
$0.91
|
| 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 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 |
$554.18 |
| Max. Negotiated Rate |
$2,493.79 |
| Rate for Payer: Blue Shield of California Commercial |
$2,078.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,479.65
|
| Rate for Payer: Cash Price |
$1,246.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.70
|
| 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: Health Management Network EPO/PPO |
$2,493.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.18
|
| Rate for Payer: Multiplan Commercial |
$2,078.16
|
| 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 |
$554.18 |
| Max. Negotiated Rate |
$3,778.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$609.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,778.73
|
| 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 Exchange |
$1,043.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.98
|
| Rate for Payer: BCBS Transplant Transplant |
$1,662.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,742.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,354.96
|
| Rate for Payer: Caremore Medicare Advantage |
$609.76
|
| Rate for Payer: Cash Price |
$1,246.90
|
| Rate for Payer: Cash Price |
$1,246.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,216.70
|
| 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: 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 Management Network EPO/PPO |
$2,493.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,078.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,000.01
|
| Rate for Payer: IEHP medi-cal |
$1,006.11
|
| Rate for Payer: IEHP Medicare Advantage |
$609.76
|
| Rate for Payer: Innovage PACE Commercial |
$914.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,848.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$817.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$817.09
|
| Rate for Payer: Multiplan Commercial |
$2,078.16
|
| Rate for Payer: Networks By Design Commercial |
$1,385.44
|
| Rate for Payer: Prime Health Services Commercial |
$2,355.25
|
| Rate for Payer: Prime Health Services Medicare |
$646.35
|
| Rate for Payer: Riverside University Health MISP |
$670.74
|
| 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
IP
|
$0.28
|
|
|
Service Code
|
NDC 43547-526-03
|
| Hospital Charge Code |
1712399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| 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: Health Management Network EPO/PPO |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| 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
|
$0.56
|
|
|
Service Code
|
NDC 67877-391-30
|
| Hospital Charge Code |
1712399
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.34
|
| 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 Exchange |
$0.27
|
| 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 |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Central Health Plan Commercial |
$0.45
|
| 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: 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 Management Network EPO/PPO |
$0.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.42
|
| Rate for Payer: IEHP medi-cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| 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: Riverside University Health MISP |
$0.22
|
| 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 Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
