|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
|
OP
|
$11.46
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.88
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.20
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.92
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.92
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.88
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$9.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$9.90
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$20.82 |
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,680.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$1,260.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$22.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1,575.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.52
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$27.51
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
|
OP
|
$28.80
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.28
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$22.01
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$15.62
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1,260.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$22.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$15.62
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1,260.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.28
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$1,260.00
|
| Rate for Payer: Health Smart Auto/Commercial |
$22.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1,260.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$22.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$27.51
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$19.52
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1,575.00
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
|
OP
|
$452.10
|
|
|
Service Code
|
CPT J0714
|
| Hospital Charge Code |
ERX205130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.66 |
| Max. Negotiated Rate |
$339.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$271.26
|
| Rate for Payer: Aetna of CA Government/Medicare |
$271.26
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Health Smart Auto/Commercial |
$271.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$271.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.66
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$339.08
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
|
IP
|
$452.10
|
|
|
Service Code
|
CPT J0714
|
| Hospital Charge Code |
ERX205130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.66 |
| Max. Negotiated Rate |
$361.68 |
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$361.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$271.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.66
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$339.08
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
|
OP
|
$173.23
|
|
|
Service Code
|
CPT J0695
|
| Hospital Charge Code |
ERX208439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.28 |
| Max. Negotiated Rate |
$129.92 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$103.94
|
| Rate for Payer: Aetna of CA Government/Medicare |
$103.94
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Health Smart Auto/Commercial |
$103.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$103.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$129.92
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
|
IP
|
$173.23
|
|
|
Service Code
|
CPT J0695
|
| Hospital Charge Code |
ERX208439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.28 |
| Max. Negotiated Rate |
$138.58 |
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.58
|
| Rate for Payer: Health Smart Auto/Commercial |
$103.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$129.92
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
|
OP
|
$20.78
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1750473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$15.58 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$12.47
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$20.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$11.44
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.40
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$24.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$20.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$11.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$12.47
|
| Rate for Payer: Aetna of CA Government/Medicare |
$24.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Health Smart Auto/Commercial |
$24.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$20.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$24.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$18.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$30.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$25.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$15.58
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1750473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$24.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$20.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.44
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.47
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$14.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$15.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$30.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$25.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$18.00
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
NDC 55390-311-10
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.58
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.58
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.98
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
NDC 0409-7332-01
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.10
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.37
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
NDC 55390-311-10
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.98
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
NDC 0409-7332-01
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.37
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.76
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.52
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.52
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.15
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.34
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.62
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.97
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.55
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.55
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.62
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.34
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.97
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.97
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.67
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.21
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.55
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.21
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.67
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
|
OP
|
$2.03
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1780028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.22
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.01
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.34
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.55
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.55
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.22
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.34
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.55
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.52
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.67
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
|
IP
|
$2.03
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1780028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.55
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.34
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.52
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.67
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
|
|
CEFTRIAXONE 2 GRAM INJECTION (IM) [4080783]
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.60
|
|
|
CEFTRIAXONE 2 GRAM INJECTION (IM) [4080783]
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.08
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.60
|
|
