|
CEFTRIAXONE 2 GRAM INTRAVENOUS SOLUTION [27309]
|
Facility
|
IP
|
$9.57
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX27309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.18
|
|
|
CEFTRIAXONE 2 GRAM INTRAVENOUS SOLUTION [27309]
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX27309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.74
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.74
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.18
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.42
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.40
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.82
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.08
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.24
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.62
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.62
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.82
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.40
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.02
|
|
|
CEFTRIAXONE 500 MG INJECTION (IM) [4080778]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
|
|
CEFTRIAXONE 500 MG INJECTION (IM) [4080778]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.90
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.63
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.90
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.63
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.63
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.28
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.87
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.12
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.70
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.30
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.90
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.30
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.90
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.87
|
|
|
CEFTRIAXONE/H2O IV INFUSION 100 MG/ML [4081845]
|
Facility
|
OP
|
$40.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4081845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$24.12
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$20.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$12.47
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$11.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$20.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$12.47
|
| Rate for Payer: Aetna of CA Government/Medicare |
$11.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$24.12
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$20.16
|
| 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 |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$11.44
|
| 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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$20.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| 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: Multiplan Beech St/Commercial/PHCS |
$15.58
|
| 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 |
$30.15
|
|
|
CEFTRIAXONE/H2O IV INFUSION 100 MG/ML [4081845]
|
Facility
|
IP
|
$40.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4081845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$32.16 |
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$9.35
|
| 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 |
$16.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$20.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$24.12
|
| Rate for Payer: Health Smart Auto/Commercial |
$11.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| 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 |
$18.48
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$25.20
|
| 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 |
$15.58
|
|
|
CEFTRIAXONE (ROCEPHIN) 1G/10 ML FROZEN SYRINGE [4081848]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.24
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.30
|
|
|
CEFTRIAXONE (ROCEPHIN) 1G/10 ML FROZEN SYRINGE [4081848]
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.30
|
|
|
CEFTRIAXONE (ROCEPHIN) 2G/20 ML FROZEN SYRINGE [4081846]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.24
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
|
|
CEFTRIAXONE (ROCEPHIN) 2G/20 ML FROZEN SYRINGE [4081846]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
|
|
CEFUROXIME AXETIL 250 MG TABLET [9495]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 67877-215-20
|
| Hospital Charge Code |
1711599
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.38
|
|
|
CEFUROXIME AXETIL 250 MG TABLET [9495]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 67877-215-20
|
| Hospital Charge Code |
1711599
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.31
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.38
|
|
|
CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [111827]
|
Facility
|
OP
|
$6.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
1720555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.91
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.21
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.91
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.21
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.88
|
|
|
CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [111827]
|
Facility
|
IP
|
$7.02
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
1720555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.88
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.26
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
ERX1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.11
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.11
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.63
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
ERX1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.81
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.63
|
|
|
CEFUROXIME (ZINACEF) 1.5G/15ML FROZEN SYRINGE [4081783]
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
NDC4081783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.82
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.82
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.77
|
|
|
CEFUROXIME (ZINACEF) 1.5G/15ML FROZEN SYRINGE [4081783]
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
NDC4081783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Health Smart Auto/Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.77
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.87
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.87
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.09
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.14
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.27
|
|
