|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,864.24
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$20,047.94 |
| Max. Negotiated Rate |
$26,864.24 |
| Rate for Payer: EPIC Health Plan Medicare |
$20,047.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,047.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,055.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,864.24
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$49,224.87
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$36,734.98 |
| Max. Negotiated Rate |
$49,224.87 |
| Rate for Payer: EPIC Health Plan Medicare |
$36,734.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,734.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,245.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,224.87
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,811.60
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$17,769.85 |
| Max. Negotiated Rate |
$23,811.60 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,769.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,769.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,435.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,811.60
|
|
|
NADOFARAGENE FIRADENOVEC-VNCG 3X10EXP11 VP/ML INTRAVESICAL SUSPENSION [238729]
|
Facility
|
IP
|
$18,544.05
|
|
|
Service Code
|
HCPCS J9029
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,356.47 |
| Max. Negotiated Rate |
$13,908.04 |
| Rate for Payer: Adventist Health Commercial |
$3,708.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,942.37
|
| Rate for Payer: Cash Price |
$8,344.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,530.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,013.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,585.90
|
| Rate for Payer: Heritage Provider Network Senior |
$8,585.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,356.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,636.01
|
| Rate for Payer: Multiplan Commercial |
$13,908.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,699.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,139.93
|
|
|
NADOFARAGENE FIRADENOVEC-VNCG 3X10EXP11 VP/ML INTRAVESICAL SUSPENSION [238729]
|
Facility
|
OP
|
$18,544.05
|
|
|
Service Code
|
HCPCS J9029
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,356.47 |
| Max. Negotiated Rate |
$145,450.04 |
| Rate for Payer: Adventist Health Commercial |
$3,708.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,460.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80,414.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70,764.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70,764.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145,450.04
|
| Rate for Payer: Blue Shield of California Commercial |
$61,200.00
|
| Rate for Payer: Blue Shield of California EPN |
$61,200.00
|
| Rate for Payer: Cash Price |
$8,344.82
|
| Rate for Payer: Cash Price |
$8,344.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,530.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80,414.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$70,764.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70,764.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,868.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$64,331.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,585.90
|
| Rate for Payer: Heritage Provider Network Senior |
$8,585.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,331.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,845.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,356.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73,981.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,636.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86,204.36
|
| Rate for Payer: Multiplan Commercial |
$13,908.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,417.62
|
| Rate for Payer: TriValley Medical Group Senior |
$7,417.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,699.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,139.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80,414.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70,764.77
|
| Rate for Payer: Vantage Medical Group Senior |
$70,764.77
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$6.19
|
|
|
Service Code
|
NDC 5107981201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.99
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$4.64
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$6.19
|
|
|
Service Code
|
NDC 5107981201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Adventist Health Commercial |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.02
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$4.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.48
|
| Rate for Payer: TriValley Medical Group Senior |
$2.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: Vantage Medical Group Senior |
$5.26
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6068788711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6068788721
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6068788721
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.05
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
NADOLOL 20 MG TABLET [5330]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6068788711
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.70
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
|
|
NADOLOL ORAL SUSPENSION COMPOUND 10 MG/ML [4080308]
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 9994080308
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| 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: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.23
|
| 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 9994080308
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$144.38
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$26.76
|
| Rate for Payer: Adventist Health Commercial |
$33.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.38
|
| 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 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 |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| 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 |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| 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: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.14
|
| 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 |
$113.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| 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 |
$61.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.65
|
| 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 Foundation Hospitals Commercial |
$81.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.47
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.66
|
| Rate for Payer: Multiplan Commercial |
$100.35
|
| Rate for Payer: Multiplan Commercial |
$127.39
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.94
|
| Rate for Payer: TriValley Medical Group Senior |
$67.94
|
| Rate for Payer: TriValley Medical Group Senior |
$53.52
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| 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 All Other HMO/non HMO |
$48.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.38
|
| 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 Medi-Cal |
$144.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.73
|
| Rate for Payer: Vantage Medical Group Senior |
$113.73
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION [5334]
|
Facility
|
IP
|
$169.86
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Adventist Health Commercial |
$33.97
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$26.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$76.44
|
| Rate for Payer: Cash Price |
$60.21
|
| Rate for Payer: Cash Price |
$54.00
|
| 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: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.25
|
| 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 Foundation Hospitals Medi-Cal |
$24.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.74
|
| Rate for Payer: Kaiser Foundation Hospitals 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: 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 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Adventist Health Commercial |
$2.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.89
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.81
|
| 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 |
$5.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$8.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| 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: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.92
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION [5333]
|
Facility
|
OP
|
$14.04
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Adventist Health Commercial |
$2.28
|
| Rate for Payer: Adventist Health Commercial |
$2.51
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.05
|
| 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 |
$10.66
|
| 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 Medi-Cal |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.40
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| 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 |
$5.13
|
| 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 |
$8.04
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cash Price |
$8.04
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.44
|
| 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 |
$5.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8.27
|
| Rate for Payer: Heritage Provider Network Senior |
$5.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.54
|
| 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: LLUH Dept of Risk Management WC |
$3.13
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$8.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.51
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: Multiplan Commercial |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| 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 |
$4.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| 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 |
$7.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.46
|
| 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+ |
$5.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$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 Senior |
$15.19
|
| 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 |
$10.66
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION [5335]
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Adventist Health Commercial |
$5.02
|
| Rate for Payer: Adventist Health Commercial |
$6.93
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.33
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$15.60
|
| 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 |
$11.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.61
|
| Rate for Payer: Heritage Provider Network Senior |
$16.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| 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 |
$6.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Multiplan Commercial |
$18.81
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.06
|
| 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+ |
$3.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.48
|
|
|
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 |
$5.02
|
| Rate for Payer: Adventist Health Commercial |
$6.93
|
| Rate for Payer: Adventist Health Commercial |
$2.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.50
|
| 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 |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| 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 |
$15.60
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.47
|
| 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 |
$21.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$11.61
|
| Rate for Payer: Heritage Provider Network Senior |
$16.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.27
|
| Rate for Payer: Multiplan Commercial |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$19.53
|
| Rate for Payer: Multiplan Commercial |
$18.81
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.03
|
| Rate for Payer: TriValley Medical Group Senior |
$10.03
|
| 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: United Healthcare All Other HMO/non HMO |
$12.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.06
|
| 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+ |
$8.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
IP
|
$6.59
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.78
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.18
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
OP
|
$6.59
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$1.32
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.34
|
| 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 |
$2.97
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.97
|
| Rate for Payer: TriValley Medical Group Senior |
$2.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
|
|
NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.34
|
| 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 |
$5.80
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.15
|
| Rate for Payer: TriValley Medical Group Senior |
$5.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.95
|
| Rate for Payer: Vantage Medical Group Senior |
$10.95
|
|
|
NALBUPHINE 20 MG/ML INJECTION SOLUTION [5340]
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.26
|
|
|
NALOXEGOL 25 MG TABLET [208812]
|
Facility
|
IP
|
$18.33
|
|
|
Service Code
|
NDC 8262588021
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$13.75 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.80
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.41
|
| Rate for Payer: Heritage Provider Network Senior |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$13.75
|
|
|
NALOXEGOL 25 MG TABLET [208812]
|
Facility
|
OP
|
$18.33
|
|
|
Service Code
|
NDC 8262588021
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$15.58 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.17
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California EPN |
$8.95
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.35
|
| Rate for Payer: Heritage Provider Network Senior |
$11.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.83
|
| Rate for Payer: Multiplan Commercial |
$13.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.58
|
| Rate for Payer: Vantage Medical Group Senior |
$15.58
|
|
