|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| 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: EPIC Health Plan Commercial |
$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: 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
|
|
|
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
OP
|
$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: 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 |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| 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: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| 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 |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| 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 |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 45802-143-70
|
| 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-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
OP
|
$3.81
|
|
|
Service Code
|
NDC 24208-830-60
|
| Hospital Charge Code |
1740080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.25
|
| Rate for Payer: BCBS Transplant Transplant |
$2.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.86
|
| Rate for Payer: IEHP medi-cal |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: Riverside University Health MISP |
$1.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
IP
|
$3.81
|
|
|
Service Code
|
NDC 24208-830-60
|
| Hospital Charge Code |
1740080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Central Health Plan Commercial |
$3.05
|
| Rate for Payer: Cigna of CA HMO |
$2.67
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Galaxy Health WC |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.48
|
| Rate for Payer: Prime Health Services Commercial |
$3.24
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
OP
|
$4.32
|
|
|
Service Code
|
NDC 61314-630-06
|
| Hospital Charge Code |
1740080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.24
|
| Rate for Payer: IEHP medi-cal |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: Riverside University Health MISP |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
IP
|
$4.32
|
|
|
Service Code
|
NDC 61314-630-06
|
| Hospital Charge Code |
1740080
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.02
|
| Rate for Payer: Cigna of CA PPO |
$3.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.67
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
OP
|
$10.07
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
1740060
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.95
|
| Rate for Payer: BCBS Transplant Transplant |
$6.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.55
|
| Rate for Payer: IEHP medi-cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: Riverside University Health MISP |
$4.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
IP
|
$10.07
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
1740060
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Blue Shield of California Commercial |
$7.55
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
IP
|
$10.07
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Blue Shield of California Commercial |
$7.55
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
OP
|
$10.07
|
|
|
Service Code
|
NDC 61314-646-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.95
|
| Rate for Payer: BCBS Transplant Transplant |
$6.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.55
|
| Rate for Payer: IEHP medi-cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: Riverside University Health MISP |
$4.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
IP
|
$10.07
|
|
|
Service Code
|
NDC 61314-646-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Blue Shield of California Commercial |
$7.55
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
OP
|
$10.07
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
1740064
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.95
|
| Rate for Payer: BCBS Transplant Transplant |
$6.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Central Health Plan Commercial |
$8.06
|
| Rate for Payer: Cigna of CA HMO |
$7.05
|
| Rate for Payer: Cigna of CA PPO |
$7.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.03
|
| Rate for Payer: Galaxy Health WC |
$8.56
|
| Rate for Payer: Global Benefits Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.55
|
| Rate for Payer: IEHP medi-cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: Networks By Design Commercial |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: Riverside University Health MISP |
$4.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$63,309.43
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$53,126.80 |
| Max. Negotiated Rate |
$63,309.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$53,126.80
|
| Rate for Payer: IEHP medi-cal |
$63,309.43
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$32,483.11
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$27,258.55 |
| Max. Negotiated Rate |
$32,483.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,258.55
|
| Rate for Payer: IEHP medi-cal |
$32,483.11
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$12,768.67
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$10,714.97 |
| Max. Negotiated Rate |
$12,768.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,714.97
|
| Rate for Payer: IEHP medi-cal |
$12,768.67
|
|
|
NEONATAL AFTERCARE
|
Facility
IP
|
$142,083.28
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$119,230.73 |
| Max. Negotiated Rate |
$142,083.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$119,230.73
|
| Rate for Payer: IEHP medi-cal |
$142,083.28
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$46,426.37
|
|
|
Service Code
|
APR-DRG 6032
|
| Min. Negotiated Rate |
$38,959.19 |
| Max. Negotiated Rate |
$46,426.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,959.19
|
| Rate for Payer: IEHP medi-cal |
$46,426.37
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$278,446.04
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$233,661.01 |
| Max. Negotiated Rate |
$278,446.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$233,661.01
|
| Rate for Payer: IEHP medi-cal |
$278,446.04
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$94,097.39
|
|
|
Service Code
|
APR-DRG 6033
|
| Min. Negotiated Rate |
$78,962.84 |
| Max. Negotiated Rate |
$94,097.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$78,962.84
|
| Rate for Payer: IEHP medi-cal |
$94,097.39
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
IP
|
$2,254.08
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$1,891.54 |
| Max. Negotiated Rate |
$2,254.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,891.54
|
| Rate for Payer: IEHP medi-cal |
$2,254.08
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$135,965.53
|
|
|
Service Code
|
APR-DRG 6023
|
| Min. Negotiated Rate |
$114,096.95 |
| Max. Negotiated Rate |
$135,965.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$114,096.95
|
| Rate for Payer: IEHP medi-cal |
$135,965.53
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$248,298.56
|
|
|
Service Code
|
APR-DRG 6024
|
| Min. Negotiated Rate |
$208,362.43 |
| Max. Negotiated Rate |
$248,298.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$208,362.43
|
| Rate for Payer: IEHP medi-cal |
$248,298.56
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY
|
Facility
IP
|
$20,400.17
|
|
|
Service Code
|
APR-DRG 6021
|
| Min. Negotiated Rate |
$17,119.02 |
| Max. Negotiated Rate |
$20,400.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,119.02
|
| Rate for Payer: IEHP medi-cal |
$20,400.17
|
|
