|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 0093-3196-53
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.43
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.53
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0093-3196-53
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.53
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.53
|
|
|
CEFADROXIL 500 MG CAPSULE [9436]
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 68180-180-08
|
| Hospital Charge Code |
ERX9436
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.43
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.53
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJ (100MG/ML IVPB) [1446]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1750334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.64
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.64
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.80
|
|
|
CEFAZOLIN 10 GRAM SOLUTION FOR INJ (100MG/ML IVPB) [1446]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1750334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$11.52 |
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.80
|
|
|
CEFAZOLIN 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080885]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX4080885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.15
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.98
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.98
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.98
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.57
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
|
|
CEFAZOLIN 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080885]
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX4080885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.57
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.23
|
|
|
CEFAZOLIN 1 GRAM INJECTION (IM) [4080785]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX4080785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.57
|
|
|
CEFAZOLIN 1 GRAM INJECTION (IM) [4080785]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX4080785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.15
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.98
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.98
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.15
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.98
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.57
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1720430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
|
|
CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1445]
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1720430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
|
|
CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [154193]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1753550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$10.63
|
| Rate for Payer: Aetna of CA Government/Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$10.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.74
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$13.28
|
|
|
CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK [154193]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1753550
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$14.17 |
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.17
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.74
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$13.28
|
|
|
CEFAZOLIN 300 G SOLUTION FOR INJECTION [31087]
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX31087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$219.60
|
| Rate for Payer: Aetna of CA Government/Medicare |
$219.60
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$219.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$274.50
|
|
|
CEFAZOLIN 300 G SOLUTION FOR INJECTION [31087]
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX31087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$219.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$274.50
|
|
|
CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1720629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
|
|
CEFAZOLIN 500 MG SOLUTION FOR INJECTION [1448]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
1720629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.01
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.15
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.92
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.26
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
|
|
CEFAZOLIN (ANCEF) 1G/10ML FROZEN SYRINGE [4081257]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
NDC4081257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.10
|
|
|
CEFAZOLIN (ANCEF) 1G/10ML FROZEN SYRINGE [4081257]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
NDC4081257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.10
|
|
|
CEFAZOLIN (ANCEF) 2G/20ML FROZEN SYRINGE [4081258]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
NDC4081258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.10
|
|
|
CEFAZOLIN (ANCEF) 2G/20ML FROZEN SYRINGE [4081258]
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
NDC4081258
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.10
|
|
|
CEFAZOLIN SUBCONJUNCTIVAL INJECTION [4080087]
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX4080087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.57
|
|
|
CEFAZOLIN SUBCONJUNCTIVAL INJECTION [4080087]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
ERX4080087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.98
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.03
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.98
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.15
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.25
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.98
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.44
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.57
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.23
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.29
|
|
|
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [39522]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 67877-548-88
|
| Hospital Charge Code |
NDG39522
|
|
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
|
|
