|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 0574-4031-25
|
| Hospital Charge Code |
1740306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.66
|
| Rate for Payer: Blue Shield of California Commercial |
$11.31
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.48
|
| Rate for Payer: Dignity Health Senior |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.27
|
| Rate for Payer: Heritage Provider Network Senior |
$11.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.55
|
| Rate for Payer: Multiplan Commercial |
$13.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.28
|
| Rate for Payer: TriValley Medical Group Senior |
$7.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.48
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
OP
|
$24.34
|
|
|
Service Code
|
NDC 24208-295-05
|
| Hospital Charge Code |
NDG11567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.26
|
| Rate for Payer: Blue Shield of California Commercial |
$15.12
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.69
|
| Rate for Payer: Dignity Health Senior |
$20.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.07
|
| Rate for Payer: Heritage Provider Network Senior |
$15.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$18.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.74
|
| Rate for Payer: TriValley Medical Group Senior |
$9.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.69
|
| Rate for Payer: Vantage Medical Group Senior |
$20.69
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]
|
Facility
|
IP
|
$39.97
|
|
|
Service Code
|
NDC 0065-0647-05
|
| Hospital Charge Code |
NDG11567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.46
|
| Rate for Payer: Cash Price |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.06
|
| Rate for Payer: Heritage Provider Network Senior |
$27.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 62332-518-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 70069-131-01
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Senior |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 62332-518-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.16
|
| Rate for Payer: Dignity Health Senior |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Vantage Medical Group Senior |
$3.16
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS [7995]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 70069-131-01
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.70
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.02
|
| Rate for Payer: Dignity Health Senior |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.48
|
| Rate for Payer: TriValley Medical Group Senior |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.02
|
| Rate for Payer: Vantage Medical Group Senior |
$1.02
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 61314-643-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.16
|
| Rate for Payer: Dignity Health Senior |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.49
|
| Rate for Payer: TriValley Medical Group Senior |
$1.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Vantage Medical Group Senior |
$3.16
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
IP
|
$2.80
|
|
|
Service Code
|
NDC 17478-290-10
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 24208-290-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.94
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 24208-290-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Blue Shield of California EPN |
$1.66
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.40
|
| Rate for Payer: Dignity Health Senior |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Senior |
$1.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2.40
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 17478-290-10
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.74
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.38
|
| Rate for Payer: Dignity Health Senior |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.12
|
| Rate for Payer: TriValley Medical Group Senior |
$1.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2.38
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS FOR COMPOUNDS [4087995]
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 61314-643-05
|
| Hospital Charge Code |
1740185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.56
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$2.79
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT [19769]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
1740222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.12
|
| Rate for Payer: Blue Shield of California Commercial |
$45.64
|
| Rate for Payer: Blue Shield of California EPN |
$43.14
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.48
|
| Rate for Payer: Dignity Health Senior |
$62.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.50
|
| Rate for Payer: Heritage Provider Network Senior |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Senior |
$29.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.48
|
| Rate for Payer: Vantage Medical Group Senior |
$62.48
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT [19769]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
1740222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$55.12 |
| Rate for Payer: Adventist Health Commercial |
$14.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.49
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.76
|
| Rate for Payer: Heritage Provider Network Senior |
$49.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
|
|
TOBRAMYCIN 10 MG/ML NEBULIZER SOLUTION (IV FORM) [4080724]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 63323-305-02
|
| Hospital Charge Code |
1752037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.53
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
|
|
TOBRAMYCIN 10 MG/ML NEBULIZER SOLUTION (IV FORM) [4080724]
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 63323-305-02
|
| Hospital Charge Code |
1752037
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Adventist Health Commercial |
$0.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.13
|
| Rate for Payer: Dignity Health Senior |
$3.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$2.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.47
|
| Rate for Payer: TriValley Medical Group Senior |
$1.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3.13
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]
|
Facility
|
IP
|
$100.20
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1720422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Adventist Health Commercial |
$20.04
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$18.48
|
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.49
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$67.84
|
| Rate for Payer: Heritage Provider Network Senior |
$58.49
|
| Rate for Payer: Heritage Provider Network Senior |
$62.55
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$75.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.07
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]
|
Facility
|
OP
|
$92.40
|
|
|
Service Code
|
CPT J3260
|
| Hospital Charge Code |
1720422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Adventist Health Commercial |
$18.48
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$20.04
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$2.02
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$45.09
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Senior |
$73.44
|
| Rate for Payer: Dignity Health Senior |
$85.17
|
| Rate for Payer: Dignity Health Senior |
$81.60
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$78.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.45
|
| Rate for Payer: Heritage Provider Network Senior |
$42.78
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$44.45
|
| Rate for Payer: Heritage Provider Network Senior |
$46.39
|
| Rate for Payer: Heritage Provider Network Senior |
$40.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$75.15
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Senior |
$34.56
|
| Rate for Payer: TriValley Medical Group Senior |
$38.40
|
| Rate for Payer: TriValley Medical Group Senior |
$36.96
|
| Rate for Payer: TriValley Medical Group Senior |
$40.08
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.17
|
| Rate for Payer: Vantage Medical Group Senior |
$73.44
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$85.17
|
| Rate for Payer: Vantage Medical Group Senior |
$78.54
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 43598-605-04
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.94
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.12
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-56
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$13.13 |
| Rate for Payer: Adventist Health Commercial |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.59
|
| Rate for Payer: Blue Shield of California Commercial |
$9.59
|
| Rate for Payer: Blue Shield of California EPN |
$9.07
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.13
|
| Rate for Payer: Dignity Health Senior |
$13.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.56
|
| Rate for Payer: Heritage Provider Network Senior |
$9.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.18
|
| Rate for Payer: TriValley Medical Group Senior |
$6.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.13
|
| Rate for Payer: Vantage Medical Group Senior |
$13.13
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 65162-914-46
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Adventist Health Commercial |
$0.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$1.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.46
|
| Rate for Payer: Dignity Health Senior |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.63
|
| Rate for Payer: TriValley Medical Group Senior |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.46
|
| Rate for Payer: Vantage Medical Group Senior |
$3.46
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
NDC 17478-340-38
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.12
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.20
|
| Rate for Payer: Dignity Health Senior |
$9.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.70
|
| Rate for Payer: Heritage Provider Network Senior |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.33
|
| Rate for Payer: TriValley Medical Group Senior |
$4.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9.20
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-56
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Adventist Health Commercial |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.61
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.46
|
| Rate for Payer: Heritage Provider Network Senior |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
|
|
TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION [22240]
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 0781-7171-84
|
| Hospital Charge Code |
1744078
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Adventist Health Commercial |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.61
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.46
|
| Rate for Payer: Heritage Provider Network Senior |
$10.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$11.59
|
|
