|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$297.86 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.88
|
| Rate for Payer: Heritage Provider Network Senior |
$183.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.29
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.50
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$925.32
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$693.99 |
| Rate for Payer: Adventist Health Commercial |
$185.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$494.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.48
|
| Rate for Payer: Blue Shield of California Commercial |
$189.00
|
| Rate for Payer: Blue Shield of California EPN |
$189.00
|
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$425.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.41
|
| Rate for Payer: Dignity Health Senior |
$217.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$197.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$428.42
|
| Rate for Payer: Heritage Provider Network Senior |
$428.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$197.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$441.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$249.04
|
| Rate for Payer: Multiplan Commercial |
$693.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$370.13
|
| Rate for Payer: TriValley Medical Group Senior |
$370.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$306.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.41
|
| Rate for Payer: Vantage Medical Group Senior |
$217.41
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$925.32
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$693.99 |
| Rate for Payer: Adventist Health Commercial |
$185.06
|
| Rate for Payer: Cash Price |
$508.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$425.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$428.42
|
| Rate for Payer: Heritage Provider Network Senior |
$428.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.33
|
| Rate for Payer: Multiplan Commercial |
$693.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$306.37
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$297.86 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.88
|
| Rate for Payer: Heritage Provider Network Senior |
$183.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.29
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.50
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$297.86 |
| Rate for Payer: Adventist Health Commercial |
$79.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$212.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$272.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.04
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.44
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cash Price |
$218.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.30
|
| Rate for Payer: Dignity Health Senior |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.88
|
| Rate for Payer: Heritage Provider Network Senior |
$183.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$189.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.58
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$158.86
|
| Rate for Payer: TriValley Medical Group Senior |
$158.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Vantage Medical Group Senior |
$36.30
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$495.76
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.73 |
| Max. Negotiated Rate |
$536.62 |
| Rate for Payer: Adventist Health Commercial |
$99.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$264.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$340.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$371.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$536.62
|
| Rate for Payer: Blue Shield of California Commercial |
$193.94
|
| Rate for Payer: Blue Shield of California EPN |
$193.94
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.40
|
| Rate for Payer: Dignity Health Senior |
$421.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.54
|
| Rate for Payer: Heritage Provider Network Senior |
$229.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$314.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$236.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$347.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$347.03
|
| Rate for Payer: Multiplan Commercial |
$371.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.30
|
| Rate for Payer: TriValley Medical Group Senior |
$198.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$421.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$421.40
|
| Rate for Payer: Vantage Medical Group Senior |
$421.40
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$495.76
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.73 |
| Max. Negotiated Rate |
$371.82 |
| Rate for Payer: Adventist Health Commercial |
$99.15
|
| Rate for Payer: Cash Price |
$272.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.54
|
| Rate for Payer: Heritage Provider Network Senior |
$229.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.94
|
| Rate for Payer: Multiplan Commercial |
$371.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.15
|
|
|
NOREPINEPHRINE 40 MCG/10 ML NS SYRINGE FOR ANESTHESIA [40805634]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 9994-0856-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
NOREPINEPHRINE 40 MCG/10 ML NS SYRINGE FOR ANESTHESIA [40805634]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 9994-0856-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 43066-997-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.27
|
| Rate for Payer: Dignity Health Senior |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Senior |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.27
|
| Rate for Payer: Vantage Medical Group Senior |
$1.27
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 43066-997-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 70121-1576-1
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$5.24
|
|
|
Service Code
|
NDC 67457-852-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3.20
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.45
|
| Rate for Payer: Dignity Health Senior |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.10
|
| Rate for Payer: TriValley Medical Group Senior |
$2.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.45
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.24
|
|
|
Service Code
|
NDC 67457-852-00
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$3.93
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 25021-316-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 0143-9318-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$5.24
|
|
|
Service Code
|
NDC 67457-852-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$3.93
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-14
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.73
|
| Rate for Payer: Dignity Health Senior |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: Vantage Medical Group Senior |
$5.73
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 63323-940-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 0409-3375-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.73
|
| Rate for Payer: Dignity Health Senior |
$5.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: Vantage Medical Group Senior |
$5.73
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 0143-9318-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 0143-9318-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 25021-316-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Senior |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.96
|
| Rate for Payer: TriValley Medical Group Senior |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 43066-997-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
|
