|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.13 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.70
|
| Rate for Payer: Heritage Provider Network Senior |
$391.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.11
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$114.39 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$30.88
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$33.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
| 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 |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$91.61
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$91.61
|
| Rate for Payer: Cash Price |
$84.92
|
| Rate for Payer: Cash Price |
$84.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.02
|
| 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 |
$76.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.58
|
| 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 |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Senior |
$30.60
|
| Rate for Payer: Dignity Health Senior |
$141.58
|
| Rate for Payer: Dignity Health Senior |
$119.41
|
| Rate for Payer: Dignity Health Senior |
$131.23
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| 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 |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.12
|
| Rate for Payer: Heritage Provider Network Senior |
$65.04
|
| Rate for Payer: Heritage Provider Network Senior |
$77.12
|
| Rate for Payer: Heritage Provider Network Senior |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$71.48
|
| Rate for Payer: Heritage Provider Network Senior |
$16.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.01
|
| 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 |
$6.52
|
| 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: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| 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: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.59
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$115.79
|
| Rate for Payer: Multiplan Commercial |
$124.92
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.19
|
| Rate for Payer: TriValley Medical Group Senior |
$56.19
|
| Rate for Payer: TriValley Medical Group Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Senior |
$66.62
|
| Rate for Payer: TriValley Medical Group Senior |
$61.76
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| 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 Medi-Cal |
$141.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$141.58
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$30.88
|
| Rate for Payer: Adventist Health Commercial |
$33.31
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$91.61
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$84.92
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.56
|
| 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 |
$76.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.48
|
| 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 Senior |
$71.48
|
| Rate for Payer: Heritage Provider Network Senior |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$65.04
|
| Rate for Payer: Heritage Provider Network Senior |
$77.12
|
| Rate for Payer: Heritage Provider Network Senior |
$16.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| 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: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| 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 |
$115.79
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$124.92
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
OP
|
$140.48
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Adventist Health Commercial |
$28.10
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California Commercial |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Blue Shield of California EPN |
$45.90
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$119.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.04
|
| Rate for Payer: Heritage Provider Network Senior |
$22.22
|
| 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 |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| 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: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$56.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: TriValley Medical Group Senior |
$19.20
|
| Rate for Payer: TriValley Medical Group Senior |
$56.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$119.41
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
IP
|
$140.48
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
901700025
|
|
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 |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.56
|
| 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 |
$55.56
|
| Rate for Payer: Heritage Provider Network Senior |
$22.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$105.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.51
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
NDC 70710-1047-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.50
|
| Rate for Payer: Blue Shield of California EPN |
$2.80
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.30
|
| Rate for Payer: TriValley Medical Group Senior |
$2.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$3.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.65
|
| 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 250 MG TABLET [2889]
|
Facility
|
OP
|
$6.75
|
|
|
Service Code
|
NDC 75834-242-30
|
| Hospital Charge Code |
901700029
|
|
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 |
$4.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.29
|
| Rate for Payer: Cash Price |
$3.71
|
| 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 |
$3.22
|
| 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: Molina Healthcare of CA Medi-Cal |
$4.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.72
|
| 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: United Healthcare All Other HMO/non HMO |
$3.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.74
|
| 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
|
$5.74
|
|
|
Service Code
|
NDC 70710-1047-3
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
901700029
|
|
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 |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.87
|
| Rate for Payer: Cash Price |
$4.37
|
| 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 |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.56
|
| 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: United Healthcare All Other HMO/non HMO |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.75
|
| 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
|
$7.94
|
|
|
Service Code
|
NDC 0093-5571-56
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$4.37
|
| 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 |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
|
|
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 |
901700029
|
|
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: Cash Price |
$2.87
|
| 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
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINT 3.5G BULK [4082888]
|
Facility
|
OP
|
$5.21
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$1.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.54
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.43
|
| Rate for Payer: Dignity Health Senior |
$4.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.49
|
| 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: Molina Healthcare of CA Medi-Cal |
$3.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$3.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.08
|
| Rate for Payer: TriValley Medical Group Senior |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.43
|
| Rate for Payer: Vantage Medical Group Senior |
$4.43
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
OP
|
$11.92
|
|
|
Service Code
|
NDC 24208-910-19
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7.27
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.13
|
| Rate for Payer: Dignity Health Senior |
$10.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.38
|
| Rate for Payer: Heritage Provider Network Senior |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$8.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.13
|
| Rate for Payer: Vantage Medical Group Senior |
$10.13
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
NDC 72485-670-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
IP
|
$11.92
|
|
|
Service Code
|
NDC 24208-910-19
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$8.94 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.94
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT [2888]
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
NDC 72485-670-31
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.80
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 52536-134-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California EPN |
$1.22
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.12
|
| Rate for Payer: Dignity Health Senior |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2.12
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION [2899]
|
Facility
|
IP
|
$2.49
|
|
|
Service Code
|
NDC 52536-134-13
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Adventist Health Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$1.87
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML ORAL POWDER FOR SUSPENSION [2900]
|
Facility
|
IP
|
$7.94
|
|
|
Service Code
|
NDC 24338-130-13
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$4.37
|
| 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 |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML ORAL POWDER FOR SUSPENSION [2900]
|
Facility
|
OP
|
$7.94
|
|
|
Service Code
|
NDC 24338-130-13
|
| Hospital Charge Code |
901700029
|
|
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 |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.87
|
| Rate for Payer: Cash Price |
$4.37
|
| 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 |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.56
|
| 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: United Healthcare All Other HMO/non HMO |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6.75
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$218.94 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$26.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.94
|
| Rate for Payer: Blue Shield of California Commercial |
$86.22
|
| Rate for Payer: Blue Shield of California Commercial |
$86.22
|
| Rate for Payer: Blue Shield of California EPN |
$86.22
|
| Rate for Payer: Blue Shield of California EPN |
$86.22
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$72.43
|
| Rate for Payer: Cash Price |
$72.43
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Senior |
$111.94
|
| Rate for Payer: Dignity Health Senior |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.97
|
| Rate for Payer: Heritage Provider Network Senior |
$60.97
|
| Rate for Payer: Heritage Provider Network Senior |
$111.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$98.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.68
|
| Rate for Payer: TriValley Medical Group Senior |
$52.68
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$111.94
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION [2903]
|
Facility
|
IP
|
$131.69
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Adventist Health Commercial |
$26.34
|
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$72.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.97
|
| Rate for Payer: Heritage Provider Network Senior |
$60.97
|
| Rate for Payer: Heritage Provider Network Senior |
$111.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.92
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$98.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.60
|
|
|
ERYTHROMYCIN WITH ETHANOL 2 % TOPICAL GEL [2885]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 45802-966-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.72
|
| Rate for Payer: Dignity Health Senior |
$1.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.81
|
| Rate for Payer: TriValley Medical Group Senior |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Vantage Medical Group Senior |
$1.72
|
|
|
ERYTHROMYCIN WITH ETHANOL 2 % TOPICAL GEL [2885]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 45802-966-94
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Adventist Health Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
|
