|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$81.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$91.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$84.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$91.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: BCBS Transplant Transplant |
$84.29
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: BCBS Transplant Transplant |
$34.20
|
| Rate for Payer: BCBS Transplant Transplant |
$92.63
|
| Rate for Payer: BCBS Transplant Transplant |
$99.94
|
| Rate for Payer: Blue Shield of California Commercial |
$113.79
|
| Rate for Payer: Blue Shield of California Commercial |
$42.01
|
| Rate for Payer: Blue Shield of California Commercial |
$103.53
|
| Rate for Payer: Blue Shield of California Commercial |
$122.75
|
| Rate for Payer: Blue Shield of California Commercial |
$88.44
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$116.59
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$108.07
|
| Rate for Payer: Cigna of CA HMO |
$39.90
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$108.07
|
| Rate for Payer: Cigna of CA PPO |
$116.59
|
| Rate for Payer: Cigna of CA PPO |
$39.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.58
|
| Rate for Payer: Dignity Health Media |
$48.45
|
| Rate for Payer: Dignity Health Media |
$102.00
|
| Rate for Payer: Dignity Health Media |
$131.23
|
| Rate for Payer: Dignity Health Media |
$119.41
|
| Rate for Payer: Dignity Health Media |
$141.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$131.23
|
| Rate for Payer: Galaxy Health WC |
$141.58
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$92.63
|
| Rate for Payer: Global Benefits Group Commercial |
$99.94
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$115.79
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$124.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$42.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$123.51
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Networks By Design Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$77.20
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$83.28
|
| Rate for Payer: Prime Health Services Commercial |
$141.58
|
| Rate for Payer: Prime Health Services Commercial |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$83.28
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$70.24
|
| Rate for Payer: United Healthcare All Other HMO |
$77.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$83.28
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.20
|
| Rate for Payer: United Healthcare HMO Rider |
$70.24
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$83.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$141.58
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
OP
|
$140.48
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
1755709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
| Rate for Payer: BCBS Transplant Transplant |
$57.60
|
| Rate for Payer: BCBS Transplant Transplant |
$84.29
|
| Rate for Payer: Blue Shield of California Commercial |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$103.53
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Blue Shield of California EPN |
$70.24
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Media |
$81.60
|
| Rate for Payer: Dignity Health Media |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.24
|
| Rate for Payer: United Healthcare All Other HMO |
$70.24
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70.24
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
IP
|
$140.48
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
1755709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Blue Shield of California Commercial |
$100.02
|
| Rate for Payer: Blue Shield of California Commercial |
$68.35
|
| Rate for Payer: Blue Shield of California EPN |
$49.15
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$98.34
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$98.34
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
| Rate for Payer: Galaxy Health WC |
$119.41
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$84.29
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$112.38
|
| Rate for Payer: Networks By Design Commercial |
$70.24
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.72
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$6.77
|
| 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 250 MG TABLET [2889]
|
Facility
OP
|
$12.70
|
|
|
Service Code
|
NDC 69238-1484-3
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.57
|
| Rate for Payer: BCBS Transplant Transplant |
$7.62
|
| Rate for Payer: Blue Shield of California Commercial |
$9.36
|
| Rate for Payer: Blue Shield of California EPN |
$7.42
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Media |
$10.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$10.16
|
| Rate for Payer: Networks By Design Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$10.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6.35
|
| Rate for Payer: United Healthcare HMO Rider |
$6.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.80
|
| Rate for Payer: Vantage Medical Group Senior |
$10.80
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.73
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$4.76
|
| 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
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
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.30
|
| Rate for Payer: BCBS Transplant Transplant |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.14
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Media |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$12.70
|
|
|
Service Code
|
NDC 69238-1484-3
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.50
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$10.16
|
| Rate for Payer: Networks By Design Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$10.80
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: BCBS Transplant Transplant |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.94
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.74
|
| Rate for Payer: Dignity Health Media |
$5.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Blue Shield of California Commercial |
$9.92
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$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: 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 250 MG TABLET [2889]
|
Facility
IP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.46
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.74
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Blue Shield of California Commercial |
$9.92
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.72
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$6.77
|
| 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 250 MG TABLET [2889]
|
Facility
OP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.30
|
| Rate for Payer: BCBS Transplant Transplant |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.14
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Media |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$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: 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 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: AlphaCare Medical Group Commercial/Exchange |
$17.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.51
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$12.59
|
| 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
|
$5.21
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.13
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.05
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.07
|
| 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 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
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
|
|
