|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
IP
|
$133.80
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$100.35 |
| Rate for Payer: Adventist Health Commercial |
$26.76
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$33.97
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Cash Price |
$93.42
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.95
|
| Rate for Payer: Heritage Provider Network Senior |
$61.95
|
| Rate for Payer: Heritage Provider Network Senior |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$78.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.47
|
| Rate for Payer: Multiplan Commercial |
$127.39
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$100.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$61.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.30
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
OP
|
$133.80
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$113.73 |
| Rate for Payer: Adventist Health Commercial |
$26.76
|
| Rate for Payer: Adventist Health Commercial |
$33.97
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$93.42
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$93.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.55
|
| 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: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.38
|
| Rate for Payer: Dignity Health Senior |
$144.38
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$113.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.95
|
| Rate for Payer: Heritage Provider Network Senior |
$78.65
|
| Rate for Payer: Heritage Provider Network Senior |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$61.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$100.35
|
| Rate for Payer: Multiplan Commercial |
$127.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: TriValley Medical Group Senior |
$67.94
|
| Rate for Payer: TriValley Medical Group Senior |
$53.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$61.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 Medi-Cal |
$144.38
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$144.38
|
| Rate for Payer: Vantage Medical Group Senior |
$113.73
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
OP
|
$17.87
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.19
|
| Rate for Payer: Dignity Health Senior |
$15.19
|
| Rate for Payer: Dignity Health Senior |
$11.93
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: Dignity Health Senior |
$11.73
|
| Rate for Payer: Dignity Health Senior |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.83
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$7.15
|
| Rate for Payer: TriValley Medical Group Senior |
$5.62
|
| Rate for Payer: TriValley Medical Group Senior |
$5.52
|
| Rate for Payer: TriValley Medical Group Senior |
$4.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.69
|
| 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 Senior |
$9.69
|
| Rate for Payer: Vantage Medical Group Senior |
$11.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
| Rate for Payer: Vantage Medical Group Senior |
$15.19
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
IP
|
$17.87
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.40 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$8.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.92
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
IP
|
$26.40
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Adventist Health Commercial |
$6.93
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$19.07
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Senior |
$16.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$12.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.68
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Adventist Health Commercial |
$5.28
|
| Rate for Payer: Adventist Health Commercial |
$6.93
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$19.07
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cash Price |
$19.07
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cash Price |
$14.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: Dignity Health Senior |
$22.44
|
| Rate for Payer: Dignity Health Senior |
$29.47
|
| Rate for Payer: Dignity Health Senior |
$22.13
|
| Rate for Payer: Dignity Health Senior |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.05
|
| Rate for Payer: Heritage Provider Network Senior |
$16.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$12.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.27
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Multiplan Commercial |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.42
|
| Rate for Payer: TriValley Medical Group Senior |
$13.87
|
| Rate for Payer: TriValley Medical Group Senior |
$10.42
|
| Rate for Payer: TriValley Medical Group Senior |
$4.44
|
| Rate for Payer: TriValley Medical Group Senior |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$29.47
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Adventist Health Commercial |
$0.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.55
|
| Rate for Payer: Dignity Health Senior |
$4.00
|
| Rate for Payer: Dignity Health Senior |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.88
|
| Rate for Payer: TriValley Medical Group Senior |
$1.88
|
| Rate for Payer: TriValley Medical Group Senior |
$2.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4.55
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Adventist Health Commercial |
$0.94
|
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.56
|
|
|
NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: Blue Shield of California Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.82
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.26
|
| Rate for Payer: Heritage Provider Network Senior |
$4.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$6.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.82
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.26
|
| Rate for Payer: Heritage Provider Network Senior |
$4.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$6.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.05
|
|
|
NALOXEGOL 25 MG TABLET [208812]
|
Facility
|
OP
|
$17.46
|
|
|
Service Code
|
NDC 82625-8802-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.84 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.65
|
| Rate for Payer: Blue Shield of California EPN |
$8.52
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.84
|
| Rate for Payer: Dignity Health Senior |
$14.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.81
|
| Rate for Payer: Heritage Provider Network Senior |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.84
|
| Rate for Payer: Vantage Medical Group Senior |
$14.84
|
|
|
NALOXEGOL 25 MG TABLET [208812]
|
Facility
|
IP
|
$17.46
|
|
|
Service Code
|
NDC 82625-8802-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.82
|
| Rate for Payer: Heritage Provider Network Senior |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
|
|
NALOXONE 1 MG/ML 2 ML SYRINGE - CODE [4080581]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Senior |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.56
|
|
|
NALOXONE 1 MG/ML 2 ML SYRINGE - CODE [4080581]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Senior |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE [5374]
|
Facility
|
OP
|
$18.81
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$15.99 |
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$12.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.47
|
| Rate for Payer: Blue Shield of California EPN |
$9.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.18
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$15.99
|
| Rate for Payer: Dignity Health Senior |
$16.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.71
|
| Rate for Payer: Heritage Provider Network Senior |
$8.71
|
| Rate for Payer: Heritage Provider Network Senior |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.17
|
| Rate for Payer: Multiplan Commercial |
$14.11
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Senior |
$7.52
|
| Rate for Payer: TriValley Medical Group Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.99
|
| Rate for Payer: Vantage Medical Group Senior |
$16.83
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE [5374]
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Senior |
$9.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$14.11
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.56
|
|
|
NALOXONE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080435]
|
Facility
|
OP
|
$10.45
|
|
|
Service Code
|
NDC 9994-0804-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.84
|
| Rate for Payer: Blue Shield of California Commercial |
$6.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Senior |
$8.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.88
|
|
|
NALOXONE ORAL SOLUTION (IV FORM) 0.4 MG/ML [4080435]
|
Facility
|
IP
|
$10.45
|
|
|
Service Code
|
NDC 9994-0804-35
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$7.84 |
| Rate for Payer: Adventist Health Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.07
|
| Rate for Payer: Heritage Provider Network Senior |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$7.84
|
|
|
NALTREXONE 50 MG TABLET [10685]
|
Facility
|
OP
|
$2.18
|
|
|
Service Code
|
NDC 16729-081-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.33
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.85
|
| Rate for Payer: Dignity Health Senior |
$1.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Senior |
$0.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1.85
|
|
|
NALTREXONE 50 MG TABLET [10685]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 47335-326-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
|
|
NALTREXONE 50 MG TABLET [10685]
|
Facility
|
IP
|
$2.18
|
|
|
Service Code
|
NDC 16729-081-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
|
|
NALTREXONE 50 MG TABLET [10685]
|
Facility
|
OP
|
$2.32
|
|
|
Service Code
|
NDC 0406-1170-03
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.97
|
| Rate for Payer: Dignity Health Senior |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$1.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.93
|
| Rate for Payer: TriValley Medical Group Senior |
$0.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1.97
|
|
|
NALTREXONE 50 MG TABLET [10685]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 47335-326-83
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
