|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
IP
|
$5.53
|
|
|
Service Code
|
NDC 51224-222-30
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.95
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Central Health Plan Commercial |
$4.42
|
| Rate for Payer: Cigna of CA HMO |
$3.87
|
| Rate for Payer: Cigna of CA PPO |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.11
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
| Rate for Payer: Networks By Design Commercial |
$3.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.70
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-95
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.76
|
| Rate for Payer: BCBS Transplant Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.78
|
| Rate for Payer: IEHP medi-cal |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: Riverside University Health MISP |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-25
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-95
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-25
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.76
|
| Rate for Payer: BCBS Transplant Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.01
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Central Health Plan Commercial |
$5.10
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.78
|
| Rate for Payer: IEHP medi-cal |
$2.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: Riverside University Health MISP |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
OP
|
$39.60
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$35.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.07
|
| Rate for Payer: BCBS Transplant Transplant |
$25.98
|
| Rate for Payer: BCBS Transplant Transplant |
$21.40
|
| Rate for Payer: BCBS Transplant Transplant |
$23.76
|
| Rate for Payer: Blue Shield of California Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$24.91
|
| Rate for Payer: Blue Shield of California Commercial |
$27.24
|
| Rate for Payer: Blue Shield of California EPN |
$19.36
|
| Rate for Payer: Blue Shield of California EPN |
$21.17
|
| Rate for Payer: Blue Shield of California EPN |
$17.44
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Central Health Plan Commercial |
$34.64
|
| Rate for Payer: Central Health Plan Commercial |
$28.54
|
| Rate for Payer: Central Health Plan Commercial |
$31.68
|
| Rate for Payer: Cigna of CA HMO |
$27.72
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA HMO |
$24.97
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$27.72
|
| Rate for Payer: Cigna of CA PPO |
$24.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Galaxy Health WC |
$33.66
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.76
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$32.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.16
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: Innovage PACE Commercial |
$3.81
|
| Rate for Payer: Innovage PACE Commercial |
$3.81
|
| Rate for Payer: Innovage PACE Commercial |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Networks By Design Commercial |
$19.80
|
| Rate for Payer: Networks By Design Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$2.79
|
| Rate for Payer: Riverside University Health MISP |
$2.79
|
| Rate for Payer: Riverside University Health MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.65
|
| Rate for Payer: United Healthcare All Other HMO |
$21.65
|
| Rate for Payer: United Healthcare All Other HMO |
$19.80
|
| Rate for Payer: United Healthcare All Other HMO |
$17.84
|
| Rate for Payer: United Healthcare HMO Rider |
$17.84
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare HMO Rider |
$19.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
IP
|
$39.60
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$32.48
|
| Rate for Payer: Blue Shield of California Commercial |
$29.70
|
| Rate for Payer: Blue Shield of California Commercial |
$26.75
|
| Rate for Payer: Blue Shield of California EPN |
$21.15
|
| Rate for Payer: Blue Shield of California EPN |
$19.05
|
| Rate for Payer: Blue Shield of California EPN |
$23.12
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Central Health Plan Commercial |
$31.68
|
| Rate for Payer: Central Health Plan Commercial |
$34.64
|
| Rate for Payer: Central Health Plan Commercial |
$28.54
|
| Rate for Payer: Cigna of CA HMO |
$24.97
|
| Rate for Payer: Cigna of CA HMO |
$27.72
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$24.97
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$27.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$33.66
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.76
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Networks By Design Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$19.80
|
| Rate for Payer: Prime Health Services Commercial |
$33.66
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1753314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.08
|
| Rate for Payer: BCBS Transplant Transplant |
$52.78
|
| Rate for Payer: BCBS Transplant Transplant |
$46.80
|
| Rate for Payer: BCBS Transplant Transplant |
$42.80
|
| Rate for Payer: Blue Shield of California Commercial |
$55.33
|
| Rate for Payer: Blue Shield of California Commercial |
$44.87
|
| Rate for Payer: Blue Shield of California Commercial |
$49.06
|
| Rate for Payer: Blue Shield of California EPN |
$34.89
|
| Rate for Payer: Blue Shield of California EPN |
$43.02
|
| Rate for Payer: Blue Shield of California EPN |
$38.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.07
|
| Rate for Payer: Central Health Plan Commercial |
$70.38
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$60.64
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.16
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: IEHP medi-cal |
$4.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: Innovage PACE Commercial |
$3.81
|
| Rate for Payer: Innovage PACE Commercial |
$3.81
|
| Rate for Payer: Innovage PACE Commercial |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$35.67
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$60.64
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$2.79
|
| Rate for Payer: Riverside University Health MISP |
$2.79
|
| Rate for Payer: Riverside University Health MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.67
|
| Rate for Payer: United Healthcare All Other HMO |
$35.67
|
| Rate for Payer: United Healthcare All Other HMO |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.98
|
| Rate for Payer: United Healthcare HMO Rider |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$43.98
|
| Rate for Payer: United Healthcare HMO Rider |
$35.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
IP
|
$71.34
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1753314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Blue Shield of California EPN |
$41.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California Commercial |
$53.50
|
| Rate for Payer: Blue Shield of California Commercial |
$65.98
|
| Rate for Payer: Blue Shield of California EPN |
$46.98
|
| Rate for Payer: Blue Shield of California EPN |
$38.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Central Health Plan Commercial |
$70.38
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.07
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.54
|
| Rate for Payer: Galaxy Health WC |
$60.64
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$35.67
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$60.64
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
OP
|
$148.49
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
NDG100393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$133.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$126.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.73
|
| Rate for Payer: BCBS Transplant Transplant |
$89.09
|
| Rate for Payer: Blue Shield of California Commercial |
$93.40
|
| Rate for Payer: Blue Shield of California EPN |
$72.61
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Central Health Plan Commercial |
$118.79
|
| Rate for Payer: Cigna of CA HMO |
$103.94
|
| Rate for Payer: Cigna of CA PPO |
$103.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.40
|
| Rate for Payer: Galaxy Health WC |
$126.22
|
| Rate for Payer: Global Benefits Group Commercial |
$89.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.64
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$111.37
|
| Rate for Payer: IEHP medi-cal |
$51.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$111.37
|
| Rate for Payer: Networks By Design Commercial |
$96.52
|
| Rate for Payer: Prime Health Services Commercial |
$126.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$89.09
|
| Rate for Payer: Riverside University Health MISP |
$59.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.24
|
| Rate for Payer: United Healthcare All Other HMO |
$74.24
|
| Rate for Payer: United Healthcare HMO Rider |
$74.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.22
|
| Rate for Payer: Vantage Medical Group Senior |
$126.22
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
IP
|
$148.49
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
NDG100393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$111.37
|
| Rate for Payer: Blue Shield of California EPN |
$79.29
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Central Health Plan Commercial |
$118.79
|
| Rate for Payer: Cigna of CA HMO |
$103.94
|
| Rate for Payer: Cigna of CA PPO |
$103.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.40
|
| Rate for Payer: Galaxy Health WC |
$126.22
|
| Rate for Payer: Global Benefits Group Commercial |
$89.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$111.37
|
| Rate for Payer: Networks By Design Commercial |
$96.52
|
| Rate for Payer: Prime Health Services Commercial |
$126.22
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
OP
|
$37.06
|
|
|
Service Code
|
NDC 0574-4022-35
|
| Hospital Charge Code |
1740071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$33.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.90
|
| Rate for Payer: BCBS Transplant Transplant |
$22.24
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Central Health Plan Commercial |
$29.65
|
| Rate for Payer: Cigna of CA HMO |
$25.94
|
| Rate for Payer: Cigna of CA PPO |
$25.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$31.50
|
| Rate for Payer: Global Benefits Group Commercial |
$22.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.80
|
| Rate for Payer: IEHP medi-cal |
$12.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$27.80
|
| Rate for Payer: Networks By Design Commercial |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$31.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.24
|
| Rate for Payer: Riverside University Health MISP |
$14.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.53
|
| Rate for Payer: United Healthcare All Other HMO |
$18.53
|
| Rate for Payer: United Healthcare HMO Rider |
$18.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.50
|
| Rate for Payer: Vantage Medical Group Senior |
$31.50
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
IP
|
$37.06
|
|
|
Service Code
|
NDC 0574-4022-35
|
| Hospital Charge Code |
1740071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$27.80
|
| Rate for Payer: Blue Shield of California EPN |
$19.79
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Central Health Plan Commercial |
$29.65
|
| Rate for Payer: Cigna of CA HMO |
$25.94
|
| Rate for Payer: Cigna of CA PPO |
$25.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$31.50
|
| Rate for Payer: Global Benefits Group Commercial |
$22.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$27.80
|
| Rate for Payer: Networks By Design Commercial |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$31.50
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 45802-060-03
|
| Hospital Charge Code |
1743006
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 68001-477-47
|
| Hospital Charge Code |
1743006
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
IP
|
$0.09
|
|
|
Service Code
|
NDC 0713-0280-31
|
| Hospital Charge Code |
1743006
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
NDC 0536-1256-28
|
| Hospital Charge Code |
NDG850B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.06
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 68001-477-47
|
| Hospital Charge Code |
1743006
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
OP
|
$0.15
|
|
|
Service Code
|
NDC 45802-060-01
|
| Hospital Charge Code |
1719221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: IEHP medi-cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
OP
|
$0.09
|
|
|
Service Code
|
NDC 0713-0280-31
|
| Hospital Charge Code |
1743006
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: BCBS Transplant Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.07
|
| Rate for Payer: IEHP medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 45802-060-03
|
| Hospital Charge Code |
1743006
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
IP
|
$0.15
|
|
|
Service Code
|
NDC 45802-060-01
|
| Hospital Charge Code |
1719221
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
NDC 0536-1256-28
|
| Hospital Charge Code |
NDG850B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [115118]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
NDC 45802-060-00
|
| Hospital Charge Code |
1743769
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.12
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: Riverside University Health MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [115118]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
NDC 45802-060-00
|
| Hospital Charge Code |
1743769
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
