|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
NDC 2420878055
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.06
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.57
|
| Rate for Payer: Heritage Provider Network Senior |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT [38701]
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
NDC 2420878055
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.81
|
| Rate for Payer: Blue Shield of California Commercial |
$9.53
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$7.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.67
|
| Rate for Payer: Heritage Provider Network Senior |
$9.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$11.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.25
|
| Rate for Payer: TriValley Medical Group Senior |
$6.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.28
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 4580214303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 4580214303
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 4580214301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| 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 |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 4580214301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0713026831
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 6800148345
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 6800148345
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT [854]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0713026831
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 4580214370
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT [118303]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 4580214370
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
OP
|
$3.81
|
|
|
Service Code
|
NDC 2420883060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.86
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Vantage Medical Group Senior |
$3.24
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
IP
|
$3.81
|
|
|
Service Code
|
NDC 2420883060
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.45
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 6131463006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.78
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS [10708]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 6131463006
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.11
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.73
|
| Rate for Payer: TriValley Medical Group Senior |
$1.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
|
OP
|
$10.07
|
|
|
Service Code
|
NDC 2420863562
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.23
|
| Rate for Payer: Heritage Provider Network Senior |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP [28810]
|
Facility
|
IP
|
$10.07
|
|
|
Service Code
|
NDC 2420863562
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.49
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.82
|
| Rate for Payer: Heritage Provider Network Senior |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
|
OP
|
$10.07
|
|
|
Service Code
|
NDC 2420863110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.23
|
| Rate for Payer: Heritage Provider Network Senior |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$8.56
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION [34814]
|
Facility
|
IP
|
$10.07
|
|
|
Service Code
|
NDC 2420863110
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.49
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.82
|
| Rate for Payer: Heritage Provider Network Senior |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$7.55
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$28,375.21
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$2,814.00 |
| Max. Negotiated Rate |
$28,375.21 |
| Rate for Payer: EPIC Health Plan Medicare |
$21,175.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,175.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,351.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,375.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,334.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,814.00
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$23,364.72
|
|
|
Service Code
|
MSDRG 794
|
| Min. Negotiated Rate |
$2,814.00 |
| Max. Negotiated Rate |
$23,364.72 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,436.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,436.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,051.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,364.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,334.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,814.00
|
|
|
NEOSTIGMINE 5 MG/5 ML IN STERILE WATER INJECTION SYRINGE [215593]
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.14
|
|
|
NEOSTIGMINE 5 MG/5 ML IN STERILE WATER INJECTION SYRINGE [215593]
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Multiplan Commercial |
$2.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1.37
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.07
|
| Rate for Payer: Vantage Medical Group Senior |
$3.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.21
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.14
|
|
