|
TOBRAMYCIN 0.3 % EYE OINTMENT [19769]
|
Facility
OP
|
$73.50
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
1740222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$40.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.42
|
| Rate for Payer: BCBS Transplant Transplant |
$44.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.23
|
| Rate for Payer: Blue Shield of California EPN |
$35.94
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.12
|
| Rate for Payer: IEHP medi-cal |
$25.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: Riverside University Health MISP |
$29.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO |
$36.75
|
| Rate for Payer: United Healthcare HMO Rider |
$36.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT [19769]
|
Facility
IP
|
$73.50
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
1740222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: Blue Shield of California Commercial |
$55.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.25
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Central Health Plan Commercial |
$58.80
|
| Rate for Payer: Cigna of CA HMO |
$51.45
|
| Rate for Payer: Cigna of CA PPO |
$51.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.40
|
| Rate for Payer: Galaxy Health WC |
$62.48
|
| Rate for Payer: Global Benefits Group Commercial |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Networks By Design Commercial |
$47.78
|
| Rate for Payer: Prime Health Services Commercial |
$62.48
|
|
|
TOBRAMYCIN 10 MG/ML NEBULIZER SOLUTION (IV FORM) [4080724]
|
Facility
OP
|
$3.68
|
|
|
Service Code
|
NDC 63323-305-02
|
| Hospital Charge Code |
1752037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.17
|
| Rate for Payer: BCBS Transplant Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.76
|
| Rate for Payer: IEHP medi-cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: Riverside University Health MISP |
$1.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3.13
|
|
|
TOBRAMYCIN 10 MG/ML NEBULIZER SOLUTION (IV FORM) [4080724]
|
Facility
IP
|
$3.68
|
|
|
Service Code
|
NDC 63323-305-02
|
| Hospital Charge Code |
1752037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$2.58
|
| Rate for Payer: Cigna of CA PPO |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.47
|
| Rate for Payer: Galaxy Health WC |
$3.13
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: Networks By Design Commercial |
$2.39
|
| Rate for Payer: Prime Health Services Commercial |
$3.13
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]
|
Facility
OP
|
$100.20
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1720422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$90.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$78.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$50.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: BCBS Transplant Transplant |
$60.12
|
| Rate for Payer: BCBS Transplant Transplant |
$57.60
|
| Rate for Payer: BCBS Transplant Transplant |
$55.44
|
| Rate for Payer: BCBS Transplant Transplant |
$51.84
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$80.16
|
| Rate for Payer: Central Health Plan Commercial |
$73.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$69.12
|
| Rate for Payer: Cigna of CA HMO |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA HMO |
$60.48
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$64.68
|
| Rate for Payer: Cigna of CA PPO |
$60.48
|
| Rate for Payer: Cigna of CA PPO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.56
|
| Rate for Payer: Galaxy Health WC |
$85.17
|
| Rate for Payer: Galaxy Health WC |
$73.44
|
| Rate for Payer: Galaxy Health WC |
$78.54
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$55.44
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$51.84
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$69.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$75.15
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Networks By Design Commercial |
$50.10
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$46.20
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$78.54
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$85.17
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Commercial |
$73.44
|
| Rate for Payer: Riverside University Health MISP |
$38.40
|
| Rate for Payer: Riverside University Health MISP |
$36.00
|
| Rate for Payer: Riverside University Health MISP |
$36.96
|
| Rate for Payer: Riverside University Health MISP |
$34.56
|
| Rate for Payer: Riverside University Health MISP |
$40.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.20
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.20
|
| Rate for Payer: United Healthcare All Other HMO |
$50.10
|
| Rate for Payer: United Healthcare All Other HMO |
$46.20
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$43.20
|
| Rate for Payer: United Healthcare HMO Rider |
$46.20
|
| Rate for Payer: United Healthcare HMO Rider |
$50.10
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.44
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$73.44
|
| Rate for Payer: Vantage Medical Group Senior |
$85.17
|
| Rate for Payer: Vantage Medical Group Senior |
$78.54
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]
|
Facility
IP
|
$86.40
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1720422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Blue Shield of California Commercial |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$75.15
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California Commercial |
$72.00
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Blue Shield of California EPN |
$48.06
|
| Rate for Payer: Blue Shield of California EPN |
$53.51
|
| Rate for Payer: Blue Shield of California EPN |
$51.26
|
| Rate for Payer: Blue Shield of California EPN |
$46.14
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Central Health Plan Commercial |
$80.16
|
| Rate for Payer: Central Health Plan Commercial |
$73.92
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$69.12
|
| Rate for Payer: Cigna of CA HMO |
$64.68
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$60.48
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$64.68
|
| Rate for Payer: Cigna of CA PPO |
$60.48
|
| Rate for Payer: Cigna of CA PPO |
$70.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$73.44
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$85.17
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$78.54
|
| Rate for Payer: Global Benefits Group Commercial |
$60.12
|
| Rate for Payer: Global Benefits Group Commercial |
$55.44
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$51.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$75.15
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$46.20
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$50.10
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$78.54
|
| Rate for Payer: Prime Health Services Commercial |
$85.17
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Commercial |
$73.44
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
IP
|
$2.82
|
|
|
Service Code
|
NDC 43598-605-04
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Blue Shield of California Commercial |
$2.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Central Health Plan Commercial |
$2.26
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
OP
|
$4.07
|
|
|
Service Code
|
NDC 65162-914-46
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.40
|
| Rate for Payer: BCBS Transplant Transplant |
$2.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.99
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Central Health Plan Commercial |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$2.85
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$3.46
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.05
|
| Rate for Payer: IEHP medi-cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: Networks By Design Commercial |
$2.65
|
| Rate for Payer: Prime Health Services Commercial |
$3.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.44
|
| Rate for Payer: Riverside University Health MISP |
$1.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO |
$2.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Vantage Medical Group Senior |
$3.46
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
OP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-56
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.13
|
| Rate for Payer: BCBS Transplant Transplant |
$9.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.72
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Central Health Plan Commercial |
$12.36
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$10.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.18
|
| Rate for Payer: Galaxy Health WC |
$13.13
|
| Rate for Payer: Global Benefits Group Commercial |
$9.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.59
|
| Rate for Payer: IEHP medi-cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.27
|
| Rate for Payer: Riverside University Health MISP |
$6.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7.72
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: Vantage Medical Group Senior |
$13.13
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
IP
|
$4.07
|
|
|
Service Code
|
NDC 65162-914-46
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Blue Shield of California Commercial |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$2.17
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Central Health Plan Commercial |
$3.26
|
| Rate for Payer: Cigna of CA HMO |
$2.85
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$3.46
|
| Rate for Payer: Global Benefits Group Commercial |
$2.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: Networks By Design Commercial |
$2.65
|
| Rate for Payer: Prime Health Services Commercial |
$3.46
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
OP
|
$10.82
|
|
|
Service Code
|
NDC 17478-340-38
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.39
|
| Rate for Payer: BCBS Transplant Transplant |
$6.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.29
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$7.57
|
| Rate for Payer: Cigna of CA PPO |
$7.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.12
|
| Rate for Payer: IEHP medi-cal |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.49
|
| Rate for Payer: Riverside University Health MISP |
$4.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9.20
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
IP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-56
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Blue Shield of California Commercial |
$11.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.25
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Central Health Plan Commercial |
$12.36
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$10.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: Galaxy Health WC |
$13.13
|
| Rate for Payer: Global Benefits Group Commercial |
$9.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.13
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
OP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-84
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.13
|
| Rate for Payer: BCBS Transplant Transplant |
$9.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.72
|
| Rate for Payer: Blue Shield of California EPN |
$7.56
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Central Health Plan Commercial |
$12.36
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$10.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.18
|
| Rate for Payer: Galaxy Health WC |
$13.13
|
| Rate for Payer: Global Benefits Group Commercial |
$9.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.59
|
| Rate for Payer: IEHP medi-cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.27
|
| Rate for Payer: Riverside University Health MISP |
$6.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7.72
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: Vantage Medical Group Senior |
$13.13
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
IP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-84
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Blue Shield of California Commercial |
$11.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.25
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Central Health Plan Commercial |
$12.36
|
| Rate for Payer: Cigna of CA HMO |
$10.82
|
| Rate for Payer: Cigna of CA PPO |
$10.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: Galaxy Health WC |
$13.13
|
| Rate for Payer: Global Benefits Group Commercial |
$9.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
| Rate for Payer: Networks By Design Commercial |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.13
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
OP
|
$2.82
|
|
|
Service Code
|
NDC 43598-605-04
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.67
|
| Rate for Payer: BCBS Transplant Transplant |
$1.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.38
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Central Health Plan Commercial |
$2.26
|
| Rate for Payer: Cigna of CA HMO |
$1.97
|
| Rate for Payer: Cigna of CA PPO |
$1.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.13
|
| Rate for Payer: Galaxy Health WC |
$2.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.12
|
| Rate for Payer: IEHP medi-cal |
$0.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: Networks By Design Commercial |
$1.83
|
| Rate for Payer: Prime Health Services Commercial |
$2.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: Riverside University Health MISP |
$1.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1.41
|
| Rate for Payer: United Healthcare HMO Rider |
$1.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
IP
|
$10.82
|
|
|
Service Code
|
NDC 17478-340-38
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Blue Shield of California Commercial |
$8.12
|
| Rate for Payer: Blue Shield of California EPN |
$5.78
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$7.57
|
| Rate for Payer: Cigna of CA PPO |
$7.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
NDG7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Riverside University Health MISP |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
OP
|
$0.86
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1752244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.52
|
| Rate for Payer: BCBS Transplant Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.65
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Riverside University Health MISP |
$0.35
|
| Rate for Payer: Riverside University Health MISP |
$0.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.43
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
NDG7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Central Health Plan Commercial |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Networks By Design Commercial |
$0.63
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
IP
|
$1.19
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1757631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
OP
|
$1.19
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1757631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.62
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$0.83
|
| Rate for Payer: Cigna of CA PPO |
$0.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.48
|
| Rate for Payer: Galaxy Health WC |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.89
|
| Rate for Payer: IEHP medi-cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.89
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$1.01
|
| Rate for Payer: Riverside University Health MISP |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1.01
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [7994]
|
Facility
IP
|
$0.86
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1752244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Central Health Plan Commercial |
$0.69
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.62
|
| Rate for Payer: Cigna of CA PPO |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Galaxy Health WC |
$0.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$0.65
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT [11566]
|
Facility
OP
|
$82.16
|
|
|
Service Code
|
NDC 0078-0876-01
|
| Hospital Charge Code |
1740289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.54
|
| Rate for Payer: BCBS Transplant Transplant |
$49.30
|
| Rate for Payer: Blue Shield of California Commercial |
$51.68
|
| Rate for Payer: Blue Shield of California EPN |
$40.18
|
| Rate for Payer: Cash Price |
$36.97
|
| Rate for Payer: Central Health Plan Commercial |
$65.73
|
| Rate for Payer: Cigna of CA HMO |
$57.51
|
| Rate for Payer: Cigna of CA PPO |
$57.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.86
|
| Rate for Payer: Galaxy Health WC |
$69.84
|
| Rate for Payer: Global Benefits Group Commercial |
$49.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.62
|
| Rate for Payer: IEHP medi-cal |
$28.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.43
|
| Rate for Payer: Multiplan Commercial |
$61.62
|
| Rate for Payer: Networks By Design Commercial |
$53.40
|
| Rate for Payer: Prime Health Services Commercial |
$69.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.30
|
| Rate for Payer: Riverside University Health MISP |
$32.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.08
|
| Rate for Payer: United Healthcare All Other HMO |
$41.08
|
| Rate for Payer: United Healthcare HMO Rider |
$41.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.84
|
| Rate for Payer: Vantage Medical Group Senior |
$69.84
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT [11566]
|
Facility
IP
|
$82.16
|
|
|
Service Code
|
NDC 0078-0876-01
|
| Hospital Charge Code |
1740289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Blue Shield of California Commercial |
$61.62
|
| Rate for Payer: Blue Shield of California EPN |
$43.87
|
| Rate for Payer: Cash Price |
$36.97
|
| Rate for Payer: Central Health Plan Commercial |
$65.73
|
| Rate for Payer: Cigna of CA HMO |
$57.51
|
| Rate for Payer: Cigna of CA PPO |
$57.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.86
|
| Rate for Payer: Galaxy Health WC |
$69.84
|
| Rate for Payer: Global Benefits Group Commercial |
$49.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.43
|
| Rate for Payer: Multiplan Commercial |
$61.62
|
| Rate for Payer: Networks By Design Commercial |
$53.40
|
| Rate for Payer: Prime Health Services Commercial |
$69.84
|
|
|
TOLNAFTATE 1 % TOPICAL CREAM [8020]
|
Facility
IP
|
$0.21
|
|
|
Service Code
|
NDC 51672-2020-2
|
| Hospital Charge Code |
NDG8020
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.16
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Prime Health Services Commercial |
$0.18
|
|
