|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 6255927630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| 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 |
$2.17
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 6787739230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| 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 |
$0.36
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
$3.38
|
|
|
Service Code
|
NDC 6255927630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 4354752503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| 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 |
$0.18
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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
|
$0.28
|
|
|
Service Code
|
NDC 4354752503
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
NELARABINE 5 MG/ML INTRAVENOUS SOLUTION [70267]
|
Facility
|
IP
|
$15.86
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Senior |
$6.34
|
| Rate for Payer: Galaxy Health WC |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$12.69
|
| Rate for Payer: Networks By Design Commercial |
$7.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.95
|
| Rate for Payer: United Healthcare All Other HMO |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.19
|
|
|
NELARABINE 5 MG/ML INTRAVENOUS SOLUTION [70267]
|
Facility
|
OP
|
$15.86
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$212.95 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.95
|
| Rate for Payer: Blue Shield of California Commercial |
$158.60
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.95
|
| Rate for Payer: Galaxy Health WC |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.65
|
| Rate for Payer: Multiplan Commercial |
$12.69
|
| Rate for Payer: Networks By Design Commercial |
$7.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.95
|
| Rate for Payer: United Healthcare All Other HMO |
$5.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.95
|
| Rate for Payer: Vantage Medical Group Senior |
$71.95
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 6301001030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 6301001030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 8770194584
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0713062231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| 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 |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 8770194584
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 2438514303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0713062231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 2438514303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
|
IP
|
$6.13
|
|
|
Service Code
|
NDC 2420879062
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
|
OP
|
$6.13
|
|
|
Service Code
|
NDC 2420879062
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.93
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
OP
|
$6.17
|
|
|
Service Code
|
NDC 6131463136
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.96
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.32
|
| Rate for Payer: Cigna of CA PPO |
$4.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Senior |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.24
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
NDC 2420879535
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.50
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.81
|
| Rate for Payer: Cigna of CA PPO |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$3.54
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2.73
|
| Rate for Payer: United Healthcare HMO Rider |
$2.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 2420879535
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Adventist Health Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.81
|
| Rate for Payer: Cigna of CA PPO |
$3.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Senior |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$3.54
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
|
IP
|
$6.17
|
|
|
Service Code
|
NDC 6131463136
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.32
|
| Rate for Payer: Cigna of CA PPO |
$4.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Senior |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$5.24
|
|
|
NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]
|
Facility
|
IP
|
$23.95
|
|
|
Service Code
|
NDC 6131464175
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California Commercial |
$18.42
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna of CA HMO |
$16.77
|
| Rate for Payer: Cigna of CA PPO |
$16.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.36
|
| Rate for Payer: Global Benefits Group Commercial |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$19.16
|
| Rate for Payer: Networks By Design Commercial |
$15.57
|
| Rate for Payer: Prime Health Services Commercial |
$20.36
|
|
|
NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]
|
Facility
|
OP
|
$23.95
|
|
|
Service Code
|
NDC 6131464175
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.37
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: Cigna of CA HMO |
$16.77
|
| Rate for Payer: Cigna of CA PPO |
$16.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.36
|
| Rate for Payer: Global Benefits Group Commercial |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$19.16
|
| Rate for Payer: Networks By Design Commercial |
$15.57
|
| Rate for Payer: Prime Health Services Commercial |
$20.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.36
|
| Rate for Payer: Vantage Medical Group Senior |
$20.36
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
|
OP
|
$13.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Dignity Health Medi-Cal |
$11.14
|
| Rate for Payer: Adventist Health Commercial |
$2.71
|
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.17
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$9.18
|
| Rate for Payer: Cigna of CA HMO |
$9.49
|
| Rate for Payer: Cigna of CA PPO |
$9.18
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$11.14
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Networks By Design Commercial |
$6.78
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.09
|
| Rate for Payer: United Healthcare All Other HMO |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Vantage Medical Group Senior |
$11.14
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
