|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 6846219001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 6846219001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
NAPROXEN 500 MG TABLET [5393]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 6516219010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,289.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,349.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$17,246.43
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$17,246.43 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,795.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,111.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$17,246.43
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$17,246.43 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]
|
Facility
|
OP
|
$710.34
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$532.75 |
| Rate for Payer: Adventist Health Commercial |
$142.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.38
|
| Rate for Payer: Blue Shield of California Commercial |
$29.03
|
| Rate for Payer: Blue Shield of California EPN |
$29.03
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.89
|
| Rate for Payer: Heritage Provider Network Senior |
$328.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$338.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.71
|
| Rate for Payer: Multiplan Commercial |
$532.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$284.14
|
| Rate for Payer: TriValley Medical Group Senior |
$284.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$256.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.85
|
| Rate for Payer: Vantage Medical Group Senior |
$26.85
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]
|
Facility
|
IP
|
$710.34
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.57 |
| Max. Negotiated Rate |
$532.75 |
| Rate for Payer: Adventist Health Commercial |
$142.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.46
|
| Rate for Payer: Cash Price |
$319.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.89
|
| Rate for Payer: Heritage Provider Network Senior |
$328.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.59
|
| Rate for Payer: Multiplan Commercial |
$532.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$256.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.19
|
|
|
NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]
|
Facility
|
OP
|
$3,127.91
|
|
|
Service Code
|
HCPCS J9348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$566.15 |
| Max. Negotiated Rate |
$2,345.93 |
| Rate for Payer: Adventist Health Commercial |
$625.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,933.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,027.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$753.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$684.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,277.56
|
| Rate for Payer: Blue Shield of California Commercial |
$621.20
|
| Rate for Payer: Blue Shield of California EPN |
$621.20
|
| Rate for Payer: Cash Price |
$1,407.56
|
| Rate for Payer: Cash Price |
$1,407.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,438.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$856.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$753.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$753.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,001.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$684.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$684.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,492.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$566.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$787.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$917.77
|
| Rate for Payer: Multiplan Commercial |
$2,345.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.16
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,130.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,035.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$856.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$753.39
|
| Rate for Payer: Vantage Medical Group Senior |
$753.39
|
|
|
NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION [229812]
|
Facility
|
IP
|
$3,127.91
|
|
|
Service Code
|
HCPCS J9348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$566.15 |
| Max. Negotiated Rate |
$2,345.93 |
| Rate for Payer: Adventist Health Commercial |
$625.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,014.37
|
| Rate for Payer: Cash Price |
$1,407.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,438.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,689.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$566.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.98
|
| Rate for Payer: Multiplan Commercial |
$2,345.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,130.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,035.65
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6068765221
|
| 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
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 6787739130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 4354752603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| 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 |
$0.21
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6068765211
|
| 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
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 4354752603
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| 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 |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| 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 |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 6787739130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Senior |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6068765221
|
| 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
|
|
|
NEBIVOLOL 10 MG TABLET [89286]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 6068765211
|
| 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
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 6787739230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Senior |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 4354752503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| 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 |
$0.21
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 4354752503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| 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 |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| 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 |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 6255927630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.18
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 6255927630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Senior |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 6787739230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.36
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
|
