|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
OP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.53
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.17
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
IP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.17
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
|
OP
|
$107.99
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$80.99 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$64.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$64.79
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Health Smart Auto/Commercial |
$64.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$64.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$80.99
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
|
IP
|
$107.99
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$86.39 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.39
|
| Rate for Payer: Health Smart Auto/Commercial |
$64.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.39
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$80.99
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.91
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.40
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
OP
|
$11.88
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.13
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.32
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.32
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.04
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.91
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.40
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$13.40 |
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.15
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.36
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.96
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.77
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$9.00
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.56
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$10.05
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.36
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.20
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.61
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.20
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.61
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.36
|
| Rate for Payer: Aetna of CA Government/Medicare |
$10.05
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Health Smart Auto/Commercial |
$10.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.36
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$10.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.60
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$17.96
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.77
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$12.56
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$9.00
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 65862-096-20
|
| Hospital Charge Code |
ERX9469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.69
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.69
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.36
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 65862-096-20
|
| Hospital Charge Code |
ERX9469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.36
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
IP
|
$280.23
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$224.18 |
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.16
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
OP
|
$280.23
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$210.17 |
| Rate for Payer: Health Smart Auto/Commercial |
$168.13
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$168.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$168.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$168.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$168.13
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$168.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.17
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
IP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.12 |
| Max. Negotiated Rate |
$224.18 |
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.12
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.17
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.16
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
OP
|
$280.23
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$210.17 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$168.14
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$168.13
|
| Rate for Payer: Aetna of CA Government/Medicare |
$168.14
|
| Rate for Payer: Aetna of CA Government/Medicare |
$168.13
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.14
|
| Rate for Payer: Health Smart Auto/Commercial |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$168.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.13
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.16
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$210.17
|
|
|
CEFTAZIDIME 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080886]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4080886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.84
|
|
|
CEFTAZIDIME 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080886]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4080886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.07
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.07
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.84
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
|
IP
|
$7.14
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX27290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.36
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX27290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.28
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.28
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.36
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4081895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.35
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.36
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4081895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.28
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.74
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.07
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.24
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.28
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.07
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.74
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.28
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$5.36
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1722013
|
|
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 EPO/HMO/POS/PPO |
$3.74
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.07
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.74
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.07
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.74
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.35
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$3.84
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.05
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX111787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.71
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.71
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.88
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX111787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.61
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$10.88
|
|
|
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
|
|
