|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
|
OP
|
$14.82
|
|
|
Service Code
|
NDC 0781-5405-01
|
| Hospital Charge Code |
1712008
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$2.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.12
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.60
|
| Rate for Payer: Dignity Health Senior |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.17
|
| Rate for Payer: Heritage Provider Network Senior |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.93
|
| Rate for Payer: TriValley Medical Group Senior |
$5.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
OP
|
$820.80
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
1755763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.19 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$164.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$329.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.27
|
| Rate for Payer: Blue Shield of California Commercial |
$132.19
|
| Rate for Payer: Blue Shield of California EPN |
$132.19
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.42
|
| Rate for Payer: Dignity Health Senior |
$147.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$525.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.03
|
| Rate for Payer: Heritage Provider Network Senior |
$380.03
|
| Rate for Payer: Humana Medicare |
$134.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$216.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$254.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.86
|
| Rate for Payer: Multiplan Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$328.32
|
| Rate for Payer: TriValley Medical Group Senior |
$328.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$274.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.42
|
| Rate for Payer: Vantage Medical Group Senior |
$134.02
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
IP
|
$820.80
|
|
|
Service Code
|
CPT J9179
|
| Hospital Charge Code |
1755763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$164.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.89
|
| Rate for Payer: Cash Price |
$369.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.68
|
| Rate for Payer: Heritage Provider Network Senior |
$555.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Multiplan Commercial |
$615.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$274.23
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
OP
|
$166.56
|
|
|
Service Code
|
CPT J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$141.58 |
| Rate for Payer: Adventist Health Commercial |
$33.31
|
| Rate for Payer: Adventist Health Commercial |
$30.88
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$119.41
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$131.23
|
| Rate for Payer: Dignity Health Senior |
$141.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.39
|
| Rate for Payer: Heritage Provider Network Senior |
$77.12
|
| Rate for Payer: Heritage Provider Network Senior |
$71.48
|
| Rate for Payer: Heritage Provider Network Senior |
$26.39
|
| Rate for Payer: Heritage Provider Network Senior |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$65.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: Multiplan Commercial |
$124.92
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$115.79
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Senior |
$56.19
|
| Rate for Payer: TriValley Medical Group Senior |
$22.80
|
| Rate for Payer: TriValley Medical Group Senior |
$66.62
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: TriValley Medical Group Senior |
$61.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$141.58
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Commercial |
$30.88
|
| Rate for Payer: Adventist Health Commercial |
$33.31
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.07
|
| Rate for Payer: Cash Price |
$69.48
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$74.95
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.10
|
| Rate for Payer: Heritage Provider Network Senior |
$104.52
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$95.10
|
| Rate for Payer: Heritage Provider Network Senior |
$112.76
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$124.92
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$115.79
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.04
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
IP
|
$140.48
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
1755709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$105.36 |
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$95.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.93
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
1755709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.60
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.13
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$63.22
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Senior |
$81.60
|
| Rate for Payer: Dignity Health Senior |
$119.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.04
|
| Rate for Payer: Heritage Provider Network Senior |
$65.04
|
| Rate for Payer: Heritage Provider Network Senior |
$44.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Senior |
$56.19
|
| Rate for Payer: TriValley Medical Group Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.75
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.64
|
| Rate for Payer: Heritage Provider Network Senior |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.62
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Senior |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.98
|
| Rate for Payer: Heritage Provider Network Senior |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.51
|
| Rate for Payer: TriValley Medical Group Senior |
$4.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.96 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.45
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Senior |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.66
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.75
|
| Rate for Payer: Dignity Health Senior |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.18
|
| Rate for Payer: TriValley Medical Group Senior |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6.75
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.75
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.64
|
| Rate for Payer: Heritage Provider Network Senior |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Blue Shield of California Commercial |
$8.65
|
| Rate for Payer: Blue Shield of California EPN |
$8.18
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Senior |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$12.70
|
|
|
Service Code
|
NDC 69238-1484-3
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.72
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$9.52
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$12.70
|
|
|
Service Code
|
NDC 69238-1484-3
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.45
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.80
|
| Rate for Payer: Dignity Health Senior |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.86
|
| Rate for Payer: Heritage Provider Network Senior |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$9.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.80
|
| Rate for Payer: Vantage Medical Group Senior |
$10.80
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Blue Shield of California Commercial |
$8.65
|
| Rate for Payer: Blue Shield of California EPN |
$8.18
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Senior |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Senior |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
NDC 24338-102-13
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Senior |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$11.28
|
|
|
Service Code
|
NDC 52536-103-03
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.62
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Senior |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.98
|
| Rate for Payer: Heritage Provider Network Senior |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.51
|
| Rate for Payer: TriValley Medical Group Senior |
$4.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
1710431
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.64
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.57
|
| Rate for Payer: Heritage Provider Network Senior |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.06
|
|
|
ERYTHROMYCIN 500 MG TABLET [2890]
|
Facility
|
OP
|
$20.99
|
|
|
Service Code
|
NDC 24338-104-13
|
| Hospital Charge Code |
1712322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.74
|
| Rate for Payer: Blue Shield of California Commercial |
$13.03
|
| Rate for Payer: Blue Shield of California EPN |
$12.32
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.84
|
| Rate for Payer: Dignity Health Senior |
$17.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.99
|
| Rate for Payer: Heritage Provider Network Senior |
$12.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Senior |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.84
|
| Rate for Payer: Vantage Medical Group Senior |
$17.84
|
|
|
ERYTHROMYCIN 500 MG TABLET [2890]
|
Facility
|
IP
|
$20.99
|
|
|
Service Code
|
NDC 24338-104-13
|
| Hospital Charge Code |
1712322
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.42
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.21
|
| Rate for Payer: Heritage Provider Network Senior |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.74
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 17478-070-35
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$3.01
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Senior |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Senior |
$2.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
IP
|
$5.21
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
1740208
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.91 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.58
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$3.91
|
|
