|
Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| 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 |
$4,022.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$6,637.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
IP
|
$6.19
|
|
|
Service Code
|
NDC 51079-812-01
|
| Hospital Charge Code |
1711473
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.31
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Central Health Plan Commercial |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$5.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$4.64
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.26
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
OP
|
$6.19
|
|
|
Service Code
|
NDC 51079-812-01
|
| Hospital Charge Code |
1711473
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: IEHP medi-cal |
$2.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.66
|
| Rate for Payer: BCBS Transplant Transplant |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.89
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Central Health Plan Commercial |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$4.33
|
| Rate for Payer: Cigna of CA PPO |
$4.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.48
|
| Rate for Payer: Galaxy Health WC |
$5.26
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.24
|
| Rate for Payer: Multiplan Commercial |
$4.64
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: Riverside University Health MISP |
$2.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: Vantage Medical Group Senior |
$5.26
|
|
|
NADOLOL 40 MG TABLET [5331]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
1710788
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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 |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
NADOLOL 40 MG TABLET [5331]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 69097-868-07
|
| Hospital Charge Code |
1710788
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
OP
|
$0.27
|
|
|
Service Code
|
NDC 9994-0803-08
|
| Hospital Charge Code |
1715268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| 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 Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Riverside University Health MISP |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| 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 Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
IP
|
$0.27
|
|
|
Service Code
|
NDC 9994-0803-08
|
| Hospital Charge Code |
1715268
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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 |
$0.12
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
IP
|
$133.80
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$127.40
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$71.45
|
| Rate for Payer: Blue Shield of California EPN |
$90.71
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$135.89
|
| Rate for Payer: Central Health Plan Commercial |
$107.04
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$93.66
|
| Rate for Payer: Cigna of CA HMO |
$118.90
|
| Rate for Payer: Cigna of CA PPO |
$118.90
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$93.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$113.73
|
| Rate for Payer: Galaxy Health WC |
$144.38
|
| Rate for Payer: Global Benefits Group Commercial |
$80.28
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$101.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$100.35
|
| Rate for Payer: Multiplan Commercial |
$127.40
|
| Rate for Payer: Networks By Design Commercial |
$66.90
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$84.93
|
| Rate for Payer: Prime Health Services Commercial |
$113.73
|
| Rate for Payer: Prime Health Services Commercial |
$144.38
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$144.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: BCBS Transplant Transplant |
$80.28
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: BCBS Transplant Transplant |
$101.92
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Central Health Plan Commercial |
$107.04
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Central Health Plan Commercial |
$135.89
|
| Rate for Payer: Cigna of CA HMO |
$118.90
|
| Rate for Payer: Cigna of CA HMO |
$93.66
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$118.90
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$93.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.52
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$113.73
|
| Rate for Payer: Galaxy Health WC |
$144.38
|
| Rate for Payer: Global Benefits Group Commercial |
$101.92
|
| Rate for Payer: Global Benefits Group Commercial |
$80.28
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$127.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$100.35
|
| Rate for Payer: IEHP medi-cal |
$42.00
|
| Rate for Payer: IEHP medi-cal |
$46.83
|
| Rate for Payer: IEHP medi-cal |
$59.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$100.35
|
| Rate for Payer: Networks By Design Commercial |
$66.90
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$84.93
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.38
|
| Rate for Payer: Prime Health Services Commercial |
$113.73
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Riverside University Health MISP |
$67.94
|
| Rate for Payer: Riverside University Health MISP |
$53.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.90
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$84.93
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.90
|
| Rate for Payer: United Healthcare HMO Rider |
$84.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$113.73
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$144.38
|
|
|
NAFCILLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [10681]
|
Facility
OP
|
$0.41
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
NDG10681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$76.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
NAFCILLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [10681]
|
Facility
IP
|
$0.41
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
NDG10681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
IP
|
$13.20
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1720545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California Commercial |
$10.12
|
| Rate for Payer: Blue Shield of California Commercial |
$10.35
|
| Rate for Payer: Blue Shield of California Commercial |
$13.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.53
|
| Rate for Payer: Blue Shield of California EPN |
$7.21
|
| Rate for Payer: Blue Shield of California EPN |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Blue Shield of California EPN |
$7.50
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$11.93
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.19
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
OP
|
$17.87
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1720545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$76.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: BCBS Transplant Transplant |
$7.92
|
| Rate for Payer: BCBS Transplant Transplant |
$10.72
|
| Rate for Payer: BCBS Transplant Transplant |
$8.42
|
| Rate for Payer: BCBS Transplant Transplant |
$8.10
|
| Rate for Payer: BCBS Transplant Transplant |
$8.28
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$9.83
|
| Rate for Payer: Cigna of CA HMO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$12.51
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.62
|
| Rate for Payer: Galaxy Health WC |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$11.93
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: IEHP medi-cal |
$4.91
|
| Rate for Payer: IEHP medi-cal |
$4.83
|
| Rate for Payer: IEHP medi-cal |
$4.62
|
| Rate for Payer: IEHP medi-cal |
$4.72
|
| Rate for Payer: IEHP medi-cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Networks By Design Commercial |
$6.75
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$8.94
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$15.19
|
| Rate for Payer: Prime Health Services Commercial |
$11.93
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$11.48
|
| Rate for Payer: Riverside University Health MISP |
$5.28
|
| Rate for Payer: Riverside University Health MISP |
$5.40
|
| Rate for Payer: Riverside University Health MISP |
$7.15
|
| Rate for Payer: Riverside University Health MISP |
$5.52
|
| Rate for Payer: Riverside University Health MISP |
$5.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.75
|
| Rate for Payer: United Healthcare All Other HMO |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO |
$8.94
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.02
|
| Rate for Payer: United Healthcare HMO Rider |
$6.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.75
|
| Rate for Payer: United Healthcare HMO Rider |
$7.02
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.48
|
| Rate for Payer: Vantage Medical Group Senior |
$15.19
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
IP
|
$26.04
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$19.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California EPN |
$13.91
|
| Rate for Payer: Blue Shield of California EPN |
$18.51
|
| Rate for Payer: Blue Shield of California EPN |
$14.10
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Central Health Plan Commercial |
$21.12
|
| Rate for Payer: Central Health Plan Commercial |
$27.74
|
| Rate for Payer: Central Health Plan Commercial |
$20.83
|
| Rate for Payer: Cigna of CA HMO |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.87
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Galaxy Health WC |
$29.47
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Global Benefits Group Commercial |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
OP
|
$34.67
|
|
|
Service Code
|
CPT S0032
|
| Hospital Charge Code |
1751022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$76.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.46
|
| Rate for Payer: BCBS Transplant Transplant |
$20.80
|
| Rate for Payer: BCBS Transplant Transplant |
$15.84
|
| Rate for Payer: BCBS Transplant Transplant |
$15.62
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Central Health Plan Commercial |
$21.12
|
| Rate for Payer: Central Health Plan Commercial |
$27.74
|
| Rate for Payer: Central Health Plan Commercial |
$20.83
|
| Rate for Payer: Cigna of CA HMO |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$18.23
|
| Rate for Payer: Cigna of CA HMO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Cigna of CA PPO |
$18.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.87
|
| Rate for Payer: Galaxy Health WC |
$29.47
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$22.44
|
| Rate for Payer: Global Benefits Group Commercial |
$20.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15.84
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.00
|
| Rate for Payer: IEHP medi-cal |
$9.24
|
| Rate for Payer: IEHP medi-cal |
$12.13
|
| Rate for Payer: IEHP medi-cal |
$9.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Networks By Design Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$29.47
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$22.44
|
| Rate for Payer: Riverside University Health MISP |
$10.56
|
| Rate for Payer: Riverside University Health MISP |
$10.42
|
| Rate for Payer: Riverside University Health MISP |
$13.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.02
|
| Rate for Payer: United Healthcare All Other HMO |
$13.02
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$17.34
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.02
|
| Rate for Payer: United Healthcare HMO Rider |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$29.47
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
IP
|
$4.86
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1720255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Central Health Plan Commercial |
$3.89
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
IP
|
$4.28
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1759515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.21
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
OP
|
$4.28
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1759515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.57
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.86
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Central Health Plan Commercial |
$3.42
|
| Rate for Payer: Cigna of CA HMO |
$3.00
|
| Rate for Payer: Cigna of CA PPO |
$3.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.71
|
| Rate for Payer: Galaxy Health WC |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$2.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.21
|
| Rate for Payer: IEHP medi-cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$3.64
|
| Rate for Payer: Riverside University Health MISP |
$1.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
OP
|
$4.86
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1720255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.86
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Central Health Plan Commercial |
$3.89
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.64
|
| Rate for Payer: IEHP medi-cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.64
|
| Rate for Payer: Networks By Design Commercial |
$2.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Riverside University Health MISP |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]
|
Facility
IP
|
$8.36
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1720411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.46
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.85
|
| Rate for Payer: Cigna of CA PPO |
$5.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$4.18
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]
|
Facility
OP
|
$8.36
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
1720411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.27
|
| Rate for Payer: BCBS Transplant Transplant |
$5.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.86
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.85
|
| Rate for Payer: Cigna of CA PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.27
|
| Rate for Payer: IEHP medi-cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$4.18
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
NALOXEGOL 12.5 MG TABLET [208811]
|
Facility
OP
|
$15.83
|
|
|
Service Code
|
NDC 57841-1300-1
|
| Hospital Charge Code |
ERX208811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.35
|
| Rate for Payer: BCBS Transplant Transplant |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.08
|
| Rate for Payer: Cigna of CA PPO |
$11.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.87
|
| Rate for Payer: IEHP medi-cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: Riverside University Health MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
NALOXEGOL 12.5 MG TABLET [208811]
|
Facility
IP
|
$15.83
|
|
|
Service Code
|
NDC 57841-1300-1
|
| Hospital Charge Code |
ERX208811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California EPN |
$8.45
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.08
|
| Rate for Payer: Cigna of CA PPO |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
|
|
NALOXEGOL 25 MG TABLET [208812]
|
Facility
OP
|
$15.83
|
|
|
Service Code
|
NDC 57841-1301-3
|
| Hospital Charge Code |
ERX208812
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.35
|
| Rate for Payer: BCBS Transplant Transplant |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.08
|
| Rate for Payer: Cigna of CA PPO |
$11.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.87
|
| Rate for Payer: IEHP medi-cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: Riverside University Health MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
NALOXEGOL 25 MG TABLET [208812]
|
Facility
OP
|
$15.83
|
|
|
Service Code
|
NDC 57841-1301-1
|
| Hospital Charge Code |
ERX208812
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.35
|
| Rate for Payer: BCBS Transplant Transplant |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$11.08
|
| Rate for Payer: Cigna of CA PPO |
$11.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.87
|
| Rate for Payer: IEHP medi-cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: Riverside University Health MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
