|
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 |
$4.36 |
| Max. Negotiated Rate |
$19.61 |
| Rate for Payer: Blue Shield of California Commercial |
$16.34
|
| Rate for Payer: Blue Shield of California EPN |
$11.64
|
| Rate for Payer: Cash Price |
$9.81
|
| Rate for Payer: Central Health Plan Commercial |
$17.43
|
| 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: Health Management Network EPO/PPO |
$19.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$16.34
|
| Rate for Payer: Networks By Design Commercial |
$14.16
|
| Rate for Payer: Prime Health Services Commercial |
$18.52
|
|
|
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 |
$2.47 |
| Max. Negotiated Rate |
$11.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.49
|
| 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 Exchange |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.28
|
| Rate for Payer: BCBS Transplant Transplant |
$7.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7.76
|
| Rate for Payer: Blue Shield of California EPN |
$6.03
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Central Health Plan Commercial |
$9.86
|
| 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: 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 Management Network EPO/PPO |
$11.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.25
|
| Rate for Payer: IEHP medi-cal |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: Multiplan Commercial |
$9.25
|
| Rate for Payer: Networks By Design Commercial |
$8.01
|
| Rate for Payer: Prime Health Services Commercial |
$10.48
|
| Rate for Payer: Riverside University Health MISP |
$4.93
|
| 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 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 |
$2.62 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Blue Shield of California Commercial |
$9.83
|
| Rate for Payer: Blue Shield of California EPN |
$7.00
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.49
|
| 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: Health Management Network EPO/PPO |
$11.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$9.83
|
| 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 |
$2.62 |
| Max. Negotiated Rate |
$11.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.96
|
| 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 Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.75
|
| Rate for Payer: BCBS Transplant Transplant |
$7.87
|
| Rate for Payer: Blue Shield of California Commercial |
$8.25
|
| Rate for Payer: Blue Shield of California EPN |
$6.41
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.49
|
| 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: 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 Management Network EPO/PPO |
$11.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.83
|
| Rate for Payer: IEHP medi-cal |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$9.83
|
| Rate for Payer: Networks By Design Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Commercial |
$11.14
|
| Rate for Payer: Riverside University Health MISP |
$5.24
|
| 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 Medi-Cal |
$11.14
|
| Rate for Payer: Vantage Medical Group Senior |
$11.14
|
|
|
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 |
$2.47 |
| Max. Negotiated Rate |
$11.10 |
| Rate for Payer: Blue Shield of California Commercial |
$9.25
|
| Rate for Payer: Blue Shield of California EPN |
$6.58
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Central Health Plan Commercial |
$9.86
|
| 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: Health Management Network EPO/PPO |
$11.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.47
|
| Rate for Payer: Multiplan Commercial |
$9.25
|
| Rate for Payer: Networks By Design Commercial |
$8.01
|
| Rate for Payer: Prime Health Services Commercial |
$10.48
|
|
|
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 |
$0.27 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| 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: Health Management Network EPO/PPO |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
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 |
$0.27 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| 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 Exchange |
$0.64
|
| 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 |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$1.06
|
| 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: 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 Management Network EPO/PPO |
$1.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: IEHP medi-cal |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.00
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: Riverside University Health MISP |
$0.53
|
| 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 Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT [849]
|
Facility
OP
|
$17.84
|
|
|
Service Code
|
NDC 24208-785-55
|
| Hospital Charge Code |
1740051
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.54
|
| Rate for Payer: BCBS Transplant Transplant |
$10.70
|
| Rate for Payer: Blue Shield of California Commercial |
$11.22
|
| Rate for Payer: Blue Shield of California EPN |
$8.72
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Central Health Plan Commercial |
$14.27
|
| Rate for Payer: Cigna of CA HMO |
$12.49
|
| Rate for Payer: Cigna of CA PPO |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$15.16
|
| Rate for Payer: Global Benefits Group Commercial |
$10.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.38
|
| Rate for Payer: IEHP medi-cal |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Networks By Design Commercial |
$11.60
|
| Rate for Payer: Prime Health Services Commercial |
$15.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.70
|
| Rate for Payer: Riverside University Health MISP |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.92
|
| Rate for Payer: United Healthcare All Other HMO |
$8.92
|
| Rate for Payer: United Healthcare HMO Rider |
$8.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.16
|
| Rate for Payer: Vantage Medical Group Senior |
$15.16
|
|
|
NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT [849]
|
Facility
IP
|
$17.84
|
|
|
Service Code
|
NDC 24208-785-55
|
| Hospital Charge Code |
1740051
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Central Health Plan Commercial |
$14.27
|
| Rate for Payer: Cigna of CA HMO |
$12.49
|
| Rate for Payer: Cigna of CA PPO |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$15.16
|
| Rate for Payer: Global Benefits Group Commercial |
$10.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$13.38
|
| Rate for Payer: Networks By Design Commercial |
$11.60
|
| Rate for Payer: Prime Health Services Commercial |
$15.16
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]
|
Facility
IP
|
$15.62
|
|
|
Service Code
|
NDC 24208-780-55
|
| Hospital Charge Code |
1740126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Blue Shield of California Commercial |
$11.72
|
| Rate for Payer: Blue Shield of California EPN |
$8.34
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Central Health Plan Commercial |
$12.50
|
| Rate for Payer: Cigna of CA HMO |
$10.93
|
| Rate for Payer: Cigna of CA PPO |
$10.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.72
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]
|
Facility
OP
|
$15.62
|
|
|
Service Code
|
NDC 24208-780-55
|
| Hospital Charge Code |
1740126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.23
|
| Rate for Payer: BCBS Transplant Transplant |
$9.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.82
|
| Rate for Payer: Blue Shield of California EPN |
$7.64
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Central Health Plan Commercial |
$12.50
|
| Rate for Payer: Cigna of CA HMO |
$10.93
|
| Rate for Payer: Cigna of CA PPO |
$10.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.72
|
| Rate for Payer: IEHP medi-cal |
$5.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.72
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.37
|
| Rate for Payer: Riverside University Health MISP |
$6.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.81
|
| Rate for Payer: United Healthcare All Other HMO |
$7.81
|
| Rate for Payer: United Healthcare HMO Rider |
$7.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.28
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
NDC 45802-143-01
|
| Hospital Charge Code |
1743108
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| 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 |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.13
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
NDC 45802-143-01
|
| Hospital Charge Code |
1743108
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 0904-0734-31
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 0904-0734-31
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 45802-143-03
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 0713-0268-31
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
IP
|
$0.20
|
|
|
Service Code
|
NDC 68001-483-45
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
NDC 68001-483-45
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.12
|
| Rate for Payer: BCBS Transplant Transplant |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.15
|
| Rate for Payer: IEHP medi-cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: Riverside University Health MISP |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 0713-0268-31
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.09
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 45802-143-03
|
| Hospital Charge Code |
1743560
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 47682-223-35
|
| Hospital Charge Code |
1743128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 45802-061-70
|
| Hospital Charge Code |
1743128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| 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 |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 47682-223-35
|
| Hospital Charge Code |
1743128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 0904-6680-67
|
| Hospital Charge Code |
1743128
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| 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 |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
