|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
NDC 62559-276-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
OP
|
$0.56
|
|
|
Service Code
|
NDC 67877-392-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: BCBS Transplant Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.33
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: Cigna of CA HMO |
$0.39
|
| Rate for Payer: Cigna of CA PPO |
$0.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.36
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.28
|
| Rate for Payer: United Healthcare All Other HMO |
$0.28
|
| Rate for Payer: United Healthcare HMO Rider |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
IP
|
$6.96
|
|
|
Service Code
|
NDC 0456-1405-30
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Blue Shield of California Commercial |
$4.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.56
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cigna of CA HMO |
$4.87
|
| Rate for Payer: Cigna of CA PPO |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.57
|
| Rate for Payer: Networks By Design Commercial |
$4.52
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
IP
|
$0.28
|
|
|
Service Code
|
NDC 43547-525-03
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
NEBIVOLOL 5 MG TABLET [89284]
|
Facility
OP
|
$0.28
|
|
|
Service Code
|
NDC 43547-525-03
|
| Hospital Charge Code |
1712386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: BCBS Transplant Transplant |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Media |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO |
$0.14
|
| Rate for Payer: United Healthcare HMO Rider |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]
|
Facility
IP
|
$15.86
|
|
|
Service Code
|
CPT J9261
|
| Hospital Charge Code |
1755714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$8.12
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.34
|
| Rate for Payer: Galaxy Health WC |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Multiplan Commercial |
$12.69
|
| Rate for Payer: Networks By Design Commercial |
$7.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.48
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION [70267]
|
Facility
OP
|
$15.86
|
|
|
Service Code
|
CPT J9261
|
| Hospital Charge Code |
1755714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$218.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$138.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$122.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$122.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.66
|
| Rate for Payer: BCBS Transplant Transplant |
$9.52
|
| Rate for Payer: Blue Shield of California Commercial |
$11.69
|
| Rate for Payer: Blue Shield of California EPN |
$176.49
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cash Price |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$11.10
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.47
|
| Rate for Payer: Dignity Health Media |
$110.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$110.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$110.98
|
| Rate for Payer: Galaxy Health WC |
$13.48
|
| Rate for Payer: Global Benefits Group Commercial |
$9.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$182.01
|
| Rate for Payer: IEHP Medi-Cal |
$179.79
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$179.79
|
| Rate for Payer: IEHP Medicare Advantage |
$110.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.72
|
| Rate for Payer: Multiplan Commercial |
$12.69
|
| Rate for Payer: Networks By Design Commercial |
$7.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7.93
|
| Rate for Payer: United Healthcare HMO Rider |
$7.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.08
|
| Rate for Payer: Vantage Medical Group Senior |
$110.98
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
IP
|
$4.86
|
|
|
Service Code
|
NDC 63010-010-30
|
| Hospital Charge Code |
1712238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
|
|
NELFINAVIR 250 MG TABLET [20032]
|
Facility
OP
|
$4.86
|
|
|
Service Code
|
NDC 63010-010-30
|
| Hospital Charge Code |
1712238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.90
|
| Rate for Payer: BCBS Transplant Transplant |
$2.92
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna of CA HMO |
$3.40
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.13
|
| Rate for Payer: Dignity Health Media |
$4.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.17
|
| Rate for Payer: Multiplan Commercial |
$3.89
|
| Rate for Payer: Networks By Design Commercial |
$3.16
|
| Rate for Payer: Prime Health Services Commercial |
$4.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.13
|
| Rate for Payer: Vantage Medical Group Senior |
$4.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
OP
|
$0.15
|
|
|
Service Code
|
NDC 0713-0622-31
|
| Hospital Charge Code |
NDG21070C
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT [21070]
|
Facility
IP
|
$0.15
|
|
|
Service Code
|
NDC 0713-0622-31
|
| Hospital Charge Code |
NDG21070C
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
OP
|
$6.13
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
1740124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.65
|
| Rate for Payer: BCBS Transplant Transplant |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.52
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Media |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS [5474]
|
Facility
IP
|
$6.13
|
|
|
Service Code
|
NDC 24208-790-62
|
| Hospital Charge Code |
1740124
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Blue Shield of California Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
OP
|
$6.17
|
|
|
Service Code
|
NDC 61314-631-36
|
| Hospital Charge Code |
1740083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: BCBS Transplant Transplant |
$3.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.32
|
| Rate for Payer: Cigna of CA PPO |
$4.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.24
|
| Rate for Payer: Dignity Health Media |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$5.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.24
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
IP
|
$5.45
|
|
|
Service Code
|
NDC 24208-795-35
|
| Hospital Charge Code |
1740083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Blue Shield of California Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.79
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$3.54
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
IP
|
$6.17
|
|
|
Service Code
|
NDC 61314-631-36
|
| Hospital Charge Code |
1740083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Blue Shield of California Commercial |
$4.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$4.32
|
| Rate for Payer: Cigna of CA PPO |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$5.24
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT [106249]
|
Facility
OP
|
$5.45
|
|
|
Service Code
|
NDC 24208-795-35
|
| Hospital Charge Code |
1740083
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.25
|
| Rate for Payer: BCBS Transplant Transplant |
$3.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna of CA HMO |
$3.82
|
| Rate for Payer: Cigna of CA PPO |
$3.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.63
|
| Rate for Payer: Dignity Health Media |
$4.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.18
|
| Rate for Payer: Galaxy Health WC |
$4.63
|
| Rate for Payer: Global Benefits Group Commercial |
$3.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$3.54
|
| Rate for Payer: Prime Health Services Commercial |
$4.63
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other HMO |
$2.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4.63
|
|
|
NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]
|
Facility
IP
|
$21.79
|
|
|
Service Code
|
NDC 61314-641-75
|
| Hospital Charge Code |
1740204
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$11.16
|
| Rate for Payer: Cash Price |
$9.81
|
| Rate for Payer: Cigna of CA HMO |
$15.25
|
| Rate for Payer: Cigna of CA PPO |
$15.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.72
|
| Rate for Payer: Galaxy Health WC |
$18.52
|
| Rate for Payer: Global Benefits Group Commercial |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$17.43
|
| Rate for Payer: Networks By Design Commercial |
$14.16
|
| Rate for Payer: Prime Health Services Commercial |
$18.52
|
|
|
NEOMYCIN 3.5 MG-POLYMYXIN 10,000 UNIT-HYDROCORT 10 MG/ML EYE DROP,SUSP [35126]
|
Facility
OP
|
$21.79
|
|
|
Service Code
|
NDC 61314-641-75
|
| Hospital Charge Code |
1740204
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.98
|
| Rate for Payer: BCBS Transplant Transplant |
$13.07
|
| Rate for Payer: Blue Shield of California Commercial |
$16.06
|
| Rate for Payer: Blue Shield of California EPN |
$12.73
|
| Rate for Payer: Cash Price |
$9.81
|
| Rate for Payer: Cigna of CA HMO |
$15.25
|
| Rate for Payer: Cigna of CA PPO |
$15.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.52
|
| Rate for Payer: Dignity Health Media |
$18.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.72
|
| Rate for Payer: Galaxy Health WC |
$18.52
|
| Rate for Payer: Global Benefits Group Commercial |
$13.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$17.43
|
| Rate for Payer: Networks By Design Commercial |
$14.16
|
| Rate for Payer: Prime Health Services Commercial |
$18.52
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.90
|
| Rate for Payer: United Healthcare All Other HMO |
$10.90
|
| Rate for Payer: United Healthcare HMO Rider |
$10.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.52
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
IP
|
$12.33
|
|
|
Service Code
|
NDC 39822-1201-5
|
| Hospital Charge Code |
1756001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.31
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$7.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$9.86
|
| Rate for Payer: Networks By Design Commercial |
$8.01
|
| Rate for Payer: Prime Health Services Commercial |
$10.48
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
OP
|
$12.33
|
|
|
Service Code
|
NDC 39822-1201-5
|
| Hospital Charge Code |
1756001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.35
|
| Rate for Payer: BCBS Transplant Transplant |
$7.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.09
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cigna of CA HMO |
$7.89
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.48
|
| Rate for Payer: Dignity Health Media |
$10.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.93
|
| Rate for Payer: Galaxy Health WC |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$7.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$9.86
|
| Rate for Payer: Networks By Design Commercial |
$8.01
|
| Rate for Payer: Prime Health Services Commercial |
$10.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.16
|
| Rate for Payer: United Healthcare All Other HMO |
$6.16
|
| Rate for Payer: United Healthcare HMO Rider |
$6.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.48
|
| Rate for Payer: Vantage Medical Group Senior |
$10.48
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
IP
|
$13.11
|
|
|
Service Code
|
NDC 39822-1201-1
|
| Hospital Charge Code |
1756001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Blue Shield of California Commercial |
$9.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.71
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$11.14
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.49
|
| Rate for Payer: Networks By Design Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Commercial |
$11.14
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION [70678]
|
Facility
OP
|
$13.11
|
|
|
Service Code
|
NDC 39822-1201-1
|
| Hospital Charge Code |
1756001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.81
|
| Rate for Payer: BCBS Transplant Transplant |
$7.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$8.39
|
| Rate for Payer: Cigna of CA PPO |
$9.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.14
|
| Rate for Payer: Dignity Health Media |
$11.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.24
|
| Rate for Payer: Galaxy Health WC |
$11.14
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.49
|
| Rate for Payer: Networks By Design Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Commercial |
$11.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Vantage Medical Group Senior |
$11.14
|
|
|
NEOMYCIN 500 MG TABLET [5472]
|
Facility
OP
|
$1.33
|
|
|
Service Code
|
NDC 0093-1177-01
|
| Hospital Charge Code |
1711310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: Dignity Health Media |
$1.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
NEOMYCIN 500 MG TABLET [5472]
|
Facility
IP
|
$1.33
|
|
|
Service Code
|
NDC 0093-1177-01
|
| Hospital Charge Code |
1711310
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
