|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$12.70
|
|
|
Service Code
|
NDC 69238-1484-3
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.78
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Central Health Plan Commercial |
$10.16
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$10.80
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$12.70
|
|
|
Service Code
|
NDC 69238-1484-3
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.50
|
| Rate for Payer: BCBS Transplant Transplant |
$7.62
|
| Rate for Payer: Blue Shield of California Commercial |
$7.99
|
| Rate for Payer: Blue Shield of California EPN |
$6.21
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Central Health Plan Commercial |
$10.16
|
| Rate for Payer: Cigna of CA HMO |
$8.89
|
| Rate for Payer: Cigna of CA PPO |
$8.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.08
|
| Rate for Payer: Galaxy Health WC |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.52
|
| Rate for Payer: IEHP medi-cal |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$9.52
|
| Rate for Payer: Networks By Design Commercial |
$8.26
|
| Rate for Payer: Prime Health Services Commercial |
$10.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: Riverside University Health MISP |
$5.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6.35
|
| Rate for Payer: United Healthcare HMO Rider |
$6.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.80
|
| Rate for Payer: Vantage Medical Group Senior |
$10.80
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$4.24
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Central Health Plan Commercial |
$6.35
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$6.75
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Blue Shield of California Commercial |
$10.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.44
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.23
|
| Rate for Payer: BCBS Transplant Transplant |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California EPN |
$6.81
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.45
|
| Rate for Payer: IEHP medi-cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: Riverside University Health MISP |
$5.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.99
|
| Rate for Payer: BCBS Transplant Transplant |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Central Health Plan Commercial |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.06
|
| Rate for Payer: IEHP medi-cal |
$2.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$5.06
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.05
|
| Rate for Payer: Riverside University Health MISP |
$2.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.66
|
| Rate for Payer: BCBS Transplant Transplant |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.46
|
| Rate for Payer: IEHP medi-cal |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: Riverside University Health MISP |
$4.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.23
|
| Rate for Payer: BCBS Transplant Transplant |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California EPN |
$6.81
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.45
|
| Rate for Payer: IEHP medi-cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: Riverside University Health MISP |
$5.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.02
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$6.02
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Central Health Plan Commercial |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$5.06
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.74
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.69
|
| Rate for Payer: BCBS Transplant Transplant |
$4.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$3.88
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Central Health Plan Commercial |
$6.35
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$5.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.96
|
| Rate for Payer: IEHP medi-cal |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.16
|
| Rate for Payer: Prime Health Services Commercial |
$6.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.76
|
| Rate for Payer: Riverside University Health MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6.75
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
OP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.66
|
| Rate for Payer: BCBS Transplant Transplant |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$7.10
|
| Rate for Payer: Blue Shield of California EPN |
$5.52
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Cigna of CA HMO |
$7.90
|
| Rate for Payer: Cigna of CA PPO |
$7.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.46
|
| Rate for Payer: IEHP medi-cal |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: Riverside University Health MISP |
$4.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Blue Shield of California Commercial |
$10.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.44
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$9.75
|
| Rate for Payer: Cigna of CA PPO |
$9.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
ERYTHROMYCIN 500 MG TABLET [2890]
|
Facility
OP
|
$20.99
|
|
|
Service Code
|
NDC 24338-104-13
|
| Hospital Charge Code |
1712322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.40
|
| Rate for Payer: BCBS Transplant Transplant |
$12.59
|
| Rate for Payer: Blue Shield of California Commercial |
$13.20
|
| Rate for Payer: Blue Shield of California EPN |
$10.26
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.79
|
| Rate for Payer: Cigna of CA HMO |
$14.69
|
| Rate for Payer: Cigna of CA PPO |
$14.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.74
|
| Rate for Payer: IEHP medi-cal |
$7.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.74
|
| Rate for Payer: Networks By Design Commercial |
$13.64
|
| Rate for Payer: Prime Health Services Commercial |
$17.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.59
|
| Rate for Payer: Riverside University Health MISP |
$8.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.84
|
| Rate for Payer: Vantage Medical Group Senior |
$17.84
|
|
|
ERYTHROMYCIN 500 MG TABLET [2890]
|
Facility
IP
|
$20.99
|
|
|
Service Code
|
NDC 24338-104-13
|
| Hospital Charge Code |
1712322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Blue Shield of California Commercial |
$15.74
|
| Rate for Payer: Blue Shield of California EPN |
$11.21
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.79
|
| Rate for Payer: Cigna of CA HMO |
$14.69
|
| Rate for Payer: Cigna of CA PPO |
$14.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.84
|
| Rate for Payer: Global Benefits Group Commercial |
$12.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.74
|
| Rate for Payer: Networks By Design Commercial |
$13.64
|
| Rate for Payer: Prime Health Services Commercial |
$17.84
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
IP
|
$5.12
|
|
|
Service Code
|
NDC 17478-070-35
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
IP
|
$5.21
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Blue Shield of California Commercial |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Central Health Plan Commercial |
$4.17
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.91
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
OP
|
$5.21
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.08
|
| Rate for Payer: BCBS Transplant Transplant |
$3.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.28
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Central Health Plan Commercial |
$4.17
|
| Rate for Payer: Cigna of CA HMO |
$3.65
|
| Rate for Payer: Cigna of CA PPO |
$3.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.08
|
| Rate for Payer: Galaxy Health WC |
$4.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.91
|
| Rate for Payer: IEHP medi-cal |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.91
|
| Rate for Payer: Networks By Design Commercial |
$3.39
|
| Rate for Payer: Prime Health Services Commercial |
$4.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: Riverside University Health MISP |
$2.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: Vantage Medical Group Senior |
$4.43
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
OP
|
$5.12
|
|
|
Service Code
|
NDC 17478-070-35
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.02
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.50
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.84
|
| Rate for Payer: IEHP medi-cal |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
OP
|
$5.13
|
|
|
Service Code
|
NDC 0574-4024-39
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.03
|
| Rate for Payer: BCBS Transplant Transplant |
$3.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$2.51
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.85
|
| Rate for Payer: IEHP medi-cal |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.36
|
| Rate for Payer: Vantage Medical Group Senior |
$4.36
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
IP
|
$5.13
|
|
|
Service Code
|
NDC 0574-4024-39
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.59
|
| Rate for Payer: Cigna of CA PPO |
$3.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$3.85
|
| Rate for Payer: Networks By Design Commercial |
$3.33
|
| Rate for Payer: Prime Health Services Commercial |
$4.36
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
IP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Blue Shield of California Commercial |
$6.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.65
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
OP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-11
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.14
|
| Rate for Payer: BCBS Transplant Transplant |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.52
|
| Rate for Payer: IEHP medi-cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: Riverside University Health MISP |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare HMO Rider |
$4.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
OP
|
$8.70
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
1740239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.14
|
| Rate for Payer: BCBS Transplant Transplant |
$5.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$6.96
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$6.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.52
|
| Rate for Payer: IEHP medi-cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$7.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: Riverside University Health MISP |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare HMO Rider |
$4.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7.40
|
|
