|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$5.78
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.73
|
| Rate for Payer: Blue Distinction Transplant |
$4.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5.85
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$5.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.75
|
| Rate for Payer: Dignity Health Media |
$6.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.35
|
| Rate for Payer: Networks By Design Commercial |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$6.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6.75
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.72
|
| Rate for Payer: Blue Distinction Transplant |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.31
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Media |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$9.02
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
ERYTHROMYCIN 500 MG TABLET [2890]
|
Facility
|
IP
|
$20.99
|
|
|
Service Code
|
NDC 24338-104-13
|
| Hospital Charge Code |
1712322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Blue Shield of California Commercial |
$14.94
|
| Rate for Payer: Blue Shield of California EPN |
$10.75
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$14.69
|
| Rate for Payer: Cigna of CA PPO |
$14.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.79
|
| Rate for Payer: Networks By Design Commercial |
$13.64
|
| Rate for Payer: Prime Health Services Commercial |
$17.84
|
|
|
ERYTHROMYCIN 500 MG TABLET [2890]
|
Facility
|
OP
|
$20.99
|
|
|
Service Code
|
NDC 24338-104-13
|
| Hospital Charge Code |
1712322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.51
|
| Rate for Payer: Blue Distinction Transplant |
$12.59
|
| Rate for Payer: Blue Shield of California Commercial |
$15.47
|
| Rate for Payer: Blue Shield of California EPN |
$12.26
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$14.69
|
| Rate for Payer: Cigna of CA PPO |
$14.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.84
|
| Rate for Payer: Dignity Health Media |
$17.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.79
|
| Rate for Payer: Networks By Design Commercial |
$13.64
|
| Rate for Payer: Prime Health Services Commercial |
$17.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.84
|
| Rate for Payer: Vantage Medical Group Senior |
$17.84
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 17478-070-35
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.05
|
| Rate for Payer: Blue Distinction Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.99
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Media |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
NDC 17478-070-35
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
IP
|
$5.21
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Blue Shield of California Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
OP
|
$5.21
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: Blue Distinction Transplant |
$3.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.43
|
| Rate for Payer: Dignity Health Media |
$4.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.17
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: Vantage Medical Group Senior |
$4.43
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
NDC 0574-4024-39
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.06
|
| Rate for Payer: Blue Distinction Transplant |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.00
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.36
|
| Rate for Payer: Dignity Health Media |
$4.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.36
|
| Rate for Payer: Vantage Medical Group Senior |
$4.36
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.45
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-11
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.18
|
| Rate for Payer: Blue Distinction Transplant |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.40
|
| Rate for Payer: Dignity Health Media |
$7.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare HMO Rider |
$4.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
IP
|
$5.13
|
|
|
Service Code
|
NDC 0574-4024-39
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
OP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.18
|
| Rate for Payer: Blue Distinction Transplant |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.08
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.40
|
| Rate for Payer: Dignity Health Media |
$7.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare HMO Rider |
$4.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
IP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-11
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.45
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
NDC 52536-134-13
|
| Hospital Charge Code |
1715564
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: Galaxy Health WC |
$3.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$3.13
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 62559-440-01
|
| Hospital Charge Code |
1715564
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: Galaxy Health WC |
$3.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$3.11
|
| Rate for Payer: Networks By Design Commercial |
$2.53
|
| Rate for Payer: Prime Health Services Commercial |
$3.31
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 62559-440-01
|
| Hospital Charge Code |
1715564
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.32
|
| Rate for Payer: Blue Distinction Transplant |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.27
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna of CA HMO |
$2.72
|
| Rate for Payer: Cigna of CA PPO |
$2.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.31
|
| Rate for Payer: Dignity Health Media |
$3.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
| Rate for Payer: Galaxy Health WC |
$3.31
|
| Rate for Payer: Global Benefits Group Commercial |
$2.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$3.11
|
| Rate for Payer: Networks By Design Commercial |
$2.53
|
| Rate for Payer: Prime Health Services Commercial |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.31
|
| Rate for Payer: Vantage Medical Group Senior |
$3.31
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
NDC 52536-134-13
|
| Hospital Charge Code |
1715564
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.33
|
| Rate for Payer: Blue Distinction Transplant |
$2.35
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.28
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.32
|
| Rate for Payer: Dignity Health Media |
$3.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
| Rate for Payer: Galaxy Health WC |
$3.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$3.13
|
| Rate for Payer: Networks By Design Commercial |
$2.54
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO |
$1.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML ORAL POWDER FOR SUSPENSION [2900]
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 24338-130-13
|
| Hospital Charge Code |
1715582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.73
|
| Rate for Payer: Blue Distinction Transplant |
$4.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5.85
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$5.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.75
|
| Rate for Payer: Dignity Health Media |
$6.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.35
|
| Rate for Payer: Networks By Design Commercial |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$6.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6.75
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML ORAL POWDER FOR SUSPENSION [2900]
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 24338-130-13
|
| Hospital Charge Code |
1715582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Blue Shield of California Commercial |
$5.65
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.35
|
| Rate for Payer: Networks By Design Commercial |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$6.75
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET [2901]
|
Facility
|
OP
|
$14.61
|
|
|
Service Code
|
NDC 24338-110-13
|
| Hospital Charge Code |
1712209
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$12.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.70
|
| Rate for Payer: Blue Distinction Transplant |
$8.77
|
| Rate for Payer: Blue Shield of California Commercial |
$10.77
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.42
|
| Rate for Payer: Dignity Health Media |
$12.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.30
|
| Rate for Payer: United Healthcare All Other HMO |
$7.30
|
| Rate for Payer: United Healthcare HMO Rider |
$7.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.42
|
| Rate for Payer: Vantage Medical Group Senior |
$12.42
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET [2901]
|
Facility
|
IP
|
$14.61
|
|
|
Service Code
|
NDC 24338-110-13
|
| Hospital Charge Code |
1712209
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$12.42 |
| Rate for Payer: Blue Shield of California Commercial |
$10.40
|
| Rate for Payer: Blue Shield of California EPN |
$7.48
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.42
|
| Rate for Payer: Global Benefits Group Commercial |
$8.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.42
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]
|
Facility
|
IP
|
$109.06
|
|
|
Service Code
|
CPT J1364
|
| Hospital Charge Code |
1721097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Blue Shield of California Commercial |
$77.65
|
| Rate for Payer: Blue Shield of California EPN |
$55.84
|
| Rate for Payer: Cash Price |
$49.08
|
| Rate for Payer: Cigna of CA HMO |
$76.34
|
| Rate for Payer: Cigna of CA PPO |
$76.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.62
|
| Rate for Payer: Galaxy Health WC |
$92.70
|
| Rate for Payer: Global Benefits Group Commercial |
$65.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.17
|
| Rate for Payer: Multiplan Commercial |
$87.25
|
| Rate for Payer: Networks By Design Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$92.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.18
|
| Rate for Payer: United Healthcare All Other HMO |
$40.22
|
| Rate for Payer: United Healthcare HMO Rider |
$39.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.99
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]
|
Facility
|
OP
|
$109.06
|
|
|
Service Code
|
CPT J1364
|
| Hospital Charge Code |
1721097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$508.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$508.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.91
|
| Rate for Payer: Blue Distinction Transplant |
$65.44
|
| Rate for Payer: Blue Shield of California Commercial |
$80.38
|
| Rate for Payer: Blue Shield of California EPN |
$97.68
|
| Rate for Payer: Cash Price |
$49.08
|
| Rate for Payer: Cash Price |
$49.08
|
| Rate for Payer: Cigna of CA HMO |
$76.34
|
| Rate for Payer: Cigna of CA PPO |
$76.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.88
|
| Rate for Payer: Dignity Health Media |
$105.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$105.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.92
|
| Rate for Payer: Galaxy Health WC |
$92.70
|
| Rate for Payer: Global Benefits Group Commercial |
$65.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$81.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$173.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$171.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$105.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.93
|
| Rate for Payer: Multiplan Commercial |
$87.25
|
| Rate for Payer: Networks By Design Commercial |
$54.53
|
| Rate for Payer: Prime Health Services Commercial |
$92.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.53
|
| Rate for Payer: United Healthcare All Other HMO |
$54.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.51
|
| Rate for Payer: Vantage Medical Group Senior |
$105.92
|
|
