|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
OP
|
$24.34
|
|
|
Service Code
|
NDC 24208-295-05
|
| Hospital Charge Code |
NDG11567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.50
|
| Rate for Payer: Blue Distinction Transplant |
$14.60
|
| Rate for Payer: Blue Shield of California Commercial |
$17.94
|
| Rate for Payer: Blue Shield of California EPN |
$14.21
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cigna of CA HMO |
$17.04
|
| Rate for Payer: Cigna of CA PPO |
$17.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.69
|
| Rate for Payer: Dignity Health Media |
$20.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.69
|
| Rate for Payer: Global Benefits Group Commercial |
$14.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$19.47
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$20.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Other HMO |
$12.17
|
| Rate for Payer: United Healthcare HMO Rider |
$12.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.69
|
| Rate for Payer: Vantage Medical Group Senior |
$20.69
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
OP
|
$39.97
|
|
|
Service Code
|
NDC 0065-0647-05
|
| Hospital Charge Code |
NDG11567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.81
|
| Rate for Payer: Blue Distinction Transplant |
$23.98
|
| Rate for Payer: Blue Shield of California Commercial |
$29.46
|
| Rate for Payer: Blue Shield of California EPN |
$23.34
|
| Rate for Payer: Cash Price |
$17.99
|
| Rate for Payer: Cigna of CA HMO |
$27.98
|
| Rate for Payer: Cigna of CA PPO |
$27.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.97
|
| Rate for Payer: Dignity Health Media |
$33.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.99
|
| Rate for Payer: Galaxy Health WC |
$33.97
|
| Rate for Payer: Global Benefits Group Commercial |
$23.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Multiplan Commercial |
$31.98
|
| Rate for Payer: Networks By Design Commercial |
$25.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.98
|
| Rate for Payer: United Healthcare All Other HMO |
$19.98
|
| Rate for Payer: United Healthcare HMO Rider |
$19.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.97
|
| Rate for Payer: Vantage Medical Group Senior |
$33.97
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
IP
|
$24.34
|
|
|
Service Code
|
NDC 24208-295-05
|
| Hospital Charge Code |
NDG11567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Blue Shield of California Commercial |
$17.33
|
| Rate for Payer: Blue Shield of California EPN |
$12.46
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cigna of CA HMO |
$17.04
|
| Rate for Payer: Cigna of CA PPO |
$17.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.69
|
| Rate for Payer: Global Benefits Group Commercial |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$19.47
|
| Rate for Payer: Networks By Design Commercial |
$15.82
|
| Rate for Payer: Prime Health Services Commercial |
$20.69
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 0574-4031-25
|
| Hospital Charge Code |
1740306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.85
|
| Rate for Payer: Blue Distinction Transplant |
$10.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.42
|
| Rate for Payer: Blue Shield of California EPN |
$10.63
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cigna of CA HMO |
$12.75
|
| Rate for Payer: Cigna of CA PPO |
$12.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Media |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.48
|
| Rate for Payer: Global Benefits Group Commercial |
$10.93
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$14.57
|
| Rate for Payer: Networks By Design Commercial |
$11.84
|
| Rate for Payer: Prime Health Services Commercial |
$15.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.48
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
IP
|
$39.97
|
|
|
Service Code
|
NDC 0065-0647-05
|
| Hospital Charge Code |
NDG11567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Blue Shield of California Commercial |
$28.46
|
| Rate for Payer: Blue Shield of California EPN |
$20.46
|
| Rate for Payer: Cash Price |
$17.99
|
| Rate for Payer: Cigna of CA HMO |
$27.98
|
| Rate for Payer: Cigna of CA PPO |
$27.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.99
|
| Rate for Payer: Galaxy Health WC |
$33.97
|
| Rate for Payer: Global Benefits Group Commercial |
$23.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Multiplan Commercial |
$31.98
|
| Rate for Payer: Networks By Design Commercial |
$25.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.97
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 70069-131-01
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.71
|
| Rate for Payer: Blue Distinction Transplant |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$0.88
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Media |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 70069-131-01
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.78
|
| Rate for Payer: Prime Health Services Commercial |
$1.02
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 62332-518-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: Blue Distinction Transplant |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO |
$2.60
|
| Rate for Payer: Cigna of CA PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.16
|
| Rate for Payer: Dignity Health Media |
$3.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Vantage Medical Group Senior |
$3.16
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 62332-518-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO |
$2.60
|
| Rate for Payer: Cigna of CA PPO |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.16
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 17478-290-10
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 61314-643-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.22
|
| Rate for Payer: Blue Distinction Transplant |
$2.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO |
$2.60
|
| Rate for Payer: Cigna of CA PPO |
$2.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.16
|
| Rate for Payer: Dignity Health Media |
$3.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Vantage Medical Group Senior |
$3.16
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 24208-290-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: Blue Distinction Transplant |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.65
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Media |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.41
|
| Rate for Payer: United Healthcare HMO Rider |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 24208-290-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.26
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 61314-643-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO |
$2.60
|
| Rate for Payer: Cigna of CA PPO |
$2.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$3.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.98
|
| Rate for Payer: Networks By Design Commercial |
$2.42
|
| Rate for Payer: Prime Health Services Commercial |
$3.16
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 17478-290-10
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: Blue Distinction Transplant |
$1.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.96
|
| Rate for Payer: Cigna of CA PPO |
$1.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Media |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.38
|
| Rate for Payer: Global Benefits Group Commercial |
$1.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.24
|
| Rate for Payer: Networks By Design Commercial |
$1.82
|
| Rate for Payer: Prime Health Services Commercial |
$2.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT [19769]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
1740222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Blue Shield of California Commercial |
$52.33
|
| Rate for Payer: Blue Shield of California EPN |
$37.63
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT [19769]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
1740222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.79
|
| Rate for Payer: Blue Distinction Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$54.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.92
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Media |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.64
|
| Rate for Payer: Multiplan Commercial |
$58.80
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
TOBRAMYCIN 10 MG/ML NEBULIZER SOLUTION (IV FORM) [4080724]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 63323-305-02
|
| Hospital Charge Code |
1752037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
|
|
TOBRAMYCIN 10 MG/ML NEBULIZER SOLUTION (IV FORM) [4080724]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 63323-305-02
|
| Hospital Charge Code |
1752037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.19
|
| Rate for Payer: Blue Distinction Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.15
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.13
|
| Rate for Payer: Dignity Health Media |
$3.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: Multiplan Commercial |
$2.94
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3.13
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]
|
Facility
|
OP
|
$86.40
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1720422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.37
|
| Rate for Payer: Blue Distinction Transplant |
$54.00
|
| Rate for Payer: Blue Distinction Transplant |
$51.84
|
| Rate for Payer: Blue Distinction Transplant |
$60.12
|
| Rate for Payer: Blue Distinction Transplant |
$57.60
|
| Rate for Payer: Blue Distinction Transplant |
$55.44
|
| Rate for Payer: Blue Shield of California Commercial |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.33
|
| Rate for Payer: Blue Shield of California Commercial |
$73.85
|
| Rate for Payer: Blue Shield of California Commercial |
$68.10
|
| Rate for Payer: Blue Shield of California Commercial |
$63.68
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA HMO |
$60.48
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$60.48
|
| Rate for Payer: Cigna of CA PPO |
$64.68
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.17
|
| Rate for Payer: Dignity Health Media |
$85.17
|
| Rate for Payer: Dignity Health Media |
$78.54
|
| Rate for Payer: Dignity Health Media |
$81.60
|
| Rate for Payer: Dignity Health Media |
$73.44
|
| Rate for Payer: Dignity Health Media |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$73.44
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$85.17
|
| Rate for Payer: Galaxy Health WC |
$78.54
|
| Rate for Payer: Global Benefits Group Commercial |
$55.44
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$60.12
|
| Rate for Payer: Global Benefits Group Commercial |
$51.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.15
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: Multiplan Commercial |
$80.16
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$73.92
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$46.20
|
| Rate for Payer: Networks By Design Commercial |
$50.10
|
| Rate for Payer: Networks By Design Commercial |
$43.20
|
| Rate for Payer: Prime Health Services Commercial |
$78.54
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$85.17
|
| Rate for Payer: Prime Health Services Commercial |
$73.44
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.10
|
| Rate for Payer: United Healthcare All Other HMO |
$50.10
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.20
|
| Rate for Payer: United Healthcare All Other HMO |
$46.20
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.10
|
| Rate for Payer: United Healthcare HMO Rider |
$46.20
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$43.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.44
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$78.54
|
| Rate for Payer: Vantage Medical Group Senior |
$73.44
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$85.17
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]
|
Facility
|
IP
|
$100.20
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1720422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$85.17 |
| Rate for Payer: Blue Shield of California Commercial |
$71.34
|
| Rate for Payer: Blue Shield of California Commercial |
$65.79
|
| Rate for Payer: Blue Shield of California Commercial |
$68.35
|
| Rate for Payer: Blue Shield of California Commercial |
$61.52
|
| Rate for Payer: Blue Shield of California Commercial |
$64.08
|
| Rate for Payer: Blue Shield of California EPN |
$44.24
|
| Rate for Payer: Blue Shield of California EPN |
$46.08
|
| Rate for Payer: Blue Shield of California EPN |
$51.30
|
| Rate for Payer: Blue Shield of California EPN |
$49.15
|
| Rate for Payer: Blue Shield of California EPN |
$47.31
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$60.48
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$60.48
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$64.68
|
| Rate for Payer: Cigna of CA PPO |
$70.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$73.44
|
| Rate for Payer: Galaxy Health WC |
$78.54
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$85.17
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$55.44
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$51.84
|
| Rate for Payer: Global Benefits Group Commercial |
$60.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$80.16
|
| Rate for Payer: Networks By Design Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$50.10
|
| Rate for Payer: Networks By Design Commercial |
$46.20
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$78.54
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$85.17
|
| Rate for Payer: Prime Health Services Commercial |
$73.44
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.62
|
| Rate for Payer: United Healthcare All Other HMO |
$31.86
|
| Rate for Payer: United Healthcare All Other HMO |
$36.95
|
| Rate for Payer: United Healthcare All Other HMO |
$33.19
|
| Rate for Payer: United Healthcare All Other HMO |
$34.08
|
| Rate for Payer: United Healthcare All Other HMO |
$35.40
|
| Rate for Payer: United Healthcare HMO Rider |
$34.64
|
| Rate for Payer: United Healthcare HMO Rider |
$33.34
|
| Rate for Payer: United Healthcare HMO Rider |
$31.17
|
| Rate for Payer: United Healthcare HMO Rider |
$36.15
|
| Rate for Payer: United Healthcare HMO Rider |
$32.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.70
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
NDC 17478-340-38
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Blue Shield of California Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California EPN |
$5.54
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Cigna of CA HMO |
$7.57
|
| Rate for Payer: Cigna of CA PPO |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.66
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-84
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$13.13 |
| Rate for Payer: Blue Shield of California Commercial |
$11.00
|
| Rate for Payer: Blue Shield of California EPN |
$7.91
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$10.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: Galaxy Health WC |
$13.13
|
| Rate for Payer: Global Benefits Group Commercial |
$9.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$12.36
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.13
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 65162-914-46
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: Blue Distinction Transplant |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cigna of CA HMO |
$2.85
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Media |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$3.46
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.65
|
| Rate for Payer: Prime Health Services Commercial |
$3.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Vantage Medical Group Senior |
$3.46
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-56
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$13.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.21
|
| Rate for Payer: Blue Distinction Transplant |
$9.27
|
| Rate for Payer: Blue Shield of California Commercial |
$11.39
|
| Rate for Payer: Blue Shield of California EPN |
$9.02
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$10.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.13
|
| Rate for Payer: Dignity Health Media |
$13.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.18
|
| Rate for Payer: Galaxy Health WC |
$13.13
|
| Rate for Payer: Global Benefits Group Commercial |
$9.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$12.36
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7.72
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: Vantage Medical Group Senior |
$13.13
|
|
