|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.89
|
| Rate for Payer: Blue Distinction Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Media |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.89
|
| Rate for Payer: Blue Distinction Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Media |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$213.38 |
| Rate for Payer: Blue Shield of California Commercial |
$178.74
|
| Rate for Payer: Blue Shield of California EPN |
$128.53
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cigna of CA HMO |
$175.73
|
| Rate for Payer: Cigna of CA PPO |
$175.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.42
|
| Rate for Payer: Galaxy Health WC |
$213.38
|
| Rate for Payer: Global Benefits Group Commercial |
$150.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$200.83
|
| Rate for Payer: Networks By Design Commercial |
$125.52
|
| Rate for Payer: Prime Health Services Commercial |
$213.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.79
|
| Rate for Payer: United Healthcare All Other HMO |
$92.58
|
| Rate for Payer: United Healthcare HMO Rider |
$90.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.84
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
|
OP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$213.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.01
|
| Rate for Payer: Blue Distinction Transplant |
$150.62
|
| Rate for Payer: Blue Shield of California Commercial |
$185.02
|
| Rate for Payer: Blue Shield of California EPN |
$146.61
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cigna of CA HMO |
$175.73
|
| Rate for Payer: Cigna of CA PPO |
$175.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$213.38
|
| Rate for Payer: Global Benefits Group Commercial |
$150.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$188.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$200.83
|
| Rate for Payer: Networks By Design Commercial |
$125.52
|
| Rate for Payer: Prime Health Services Commercial |
$213.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.52
|
| Rate for Payer: United Healthcare All Other HMO |
$125.52
|
| Rate for Payer: United Healthcare HMO Rider |
$125.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.39
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Blue Distinction Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
|
|
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 |
$2.61 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$5.58
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$7.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.26
|
| Rate for Payer: Global Benefits Group Commercial |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$8.71
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$9.26
|
|
|
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 |
$2.61 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: Blue Distinction Transplant |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.26
|
| Rate for Payer: Dignity Health Media |
$9.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.26
|
| Rate for Payer: Global Benefits Group Commercial |
$6.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$8.71
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$9.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO |
$5.44
|
| Rate for Payer: United Healthcare HMO Rider |
$5.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Vantage Medical Group Senior |
$9.26
|
|
|
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 |
$25.92 |
| Max. Negotiated Rate |
$91.79 |
| Rate for Payer: Blue Shield of California Commercial |
$76.89
|
| Rate for Payer: Blue Shield of California EPN |
$55.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Multiplan Commercial |
$86.39
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.78
|
| Rate for Payer: United Healthcare All Other HMO |
$39.83
|
| Rate for Payer: United Healthcare HMO Rider |
$38.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.64
|
|
|
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 |
$7.66 |
| Max. Negotiated Rate |
$91.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Blue Distinction Transplant |
$64.79
|
| Rate for Payer: Blue Shield of California Commercial |
$79.59
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.79
|
| Rate for Payer: Dignity Health Media |
$91.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$80.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Multiplan Commercial |
$86.39
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.79
|
| Rate for Payer: Vantage Medical Group Senior |
$91.79
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
IP
|
$11.88
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| 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 |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
|
|
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 |
$2.85 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Distinction Transplant |
$4.32
|
| Rate for Payer: Blue Distinction Transplant |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Media |
$10.10
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$9.50
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$5.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$10.10
|
|
|
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 |
$4.02 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Blue Shield of California Commercial |
$11.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$17.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$8.58
|
| Rate for Payer: Blue Shield of California EPN |
$12.26
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$6.15
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Networks By Design Commercial |
$11.97
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Other HMO |
$8.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare HMO Rider |
$8.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.04
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare HMO Rider |
$4.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
OP
|
$7.69
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.40
|
| Rate for Payer: Blue Distinction Transplant |
$10.05
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Distinction Transplant |
$4.61
|
| Rate for Payer: Blue Distinction Transplant |
$14.36
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California Commercial |
$12.34
|
| Rate for Payer: Blue Shield of California Commercial |
$8.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.54
|
| Rate for Payer: Dignity Health Media |
$6.54
|
| Rate for Payer: Dignity Health Media |
$10.20
|
| Rate for Payer: Dignity Health Media |
$14.24
|
| Rate for Payer: Dignity Health Media |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$6.15
|
| Rate for Payer: Multiplan Commercial |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$11.97
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$3.84
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.38
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$8.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.38
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$14.24
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Blue Distinction Transplant |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Media |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$3.58
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.81
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
IP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.25 |
| Max. Negotiated Rate |
$238.19 |
| Rate for Payer: Blue Shield of California Commercial |
$199.52
|
| Rate for Payer: Blue Shield of California Commercial |
$199.52
|
| Rate for Payer: Blue Shield of California EPN |
$143.47
|
| Rate for Payer: Blue Shield of California EPN |
$143.48
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.26
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.81
|
| Rate for Payer: United Healthcare All Other HMO |
$103.35
|
| Rate for Payer: United Healthcare All Other HMO |
$103.35
|
| Rate for Payer: United Healthcare HMO Rider |
$101.10
|
| Rate for Payer: United Healthcare HMO Rider |
$101.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.48
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
OP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$238.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Blue Distinction Transplant |
$168.14
|
| Rate for Payer: Blue Distinction Transplant |
$168.13
|
| Rate for Payer: Blue Shield of California Commercial |
$206.53
|
| Rate for Payer: Blue Shield of California Commercial |
$206.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Media |
$3.84
|
| Rate for Payer: Dignity Health Media |
$3.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.29
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.29
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.12
|
| Rate for Payer: United Healthcare HMO Rider |
$140.11
|
| Rate for Payer: United Healthcare HMO Rider |
$140.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
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 |
$67.25 |
| Max. Negotiated Rate |
$238.19 |
| Rate for Payer: Blue Shield of California Commercial |
$199.52
|
| Rate for Payer: Blue Shield of California Commercial |
$199.52
|
| Rate for Payer: Blue Shield of California EPN |
$143.47
|
| Rate for Payer: Blue Shield of California EPN |
$143.48
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.26
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.81
|
| Rate for Payer: United Healthcare All Other HMO |
$103.35
|
| Rate for Payer: United Healthcare All Other HMO |
$103.35
|
| Rate for Payer: United Healthcare HMO Rider |
$101.10
|
| Rate for Payer: United Healthcare HMO Rider |
$101.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.48
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
OP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$238.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Blue Distinction Transplant |
$168.14
|
| Rate for Payer: Blue Distinction Transplant |
$168.13
|
| Rate for Payer: Blue Shield of California Commercial |
$206.53
|
| Rate for Payer: Blue Shield of California Commercial |
$206.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Media |
$3.84
|
| Rate for Payer: Dignity Health Media |
$3.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.29
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.29
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Multiplan Commercial |
$224.18
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.12
|
| Rate for Payer: United Healthcare HMO Rider |
$140.11
|
| Rate for Payer: United Healthcare HMO Rider |
$140.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
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 |
$1.23 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
|
|
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 |
$1.23 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.09
|
| Rate for Payer: Blue Distinction Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Media |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.10
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
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 |
$1.71 |
| Max. Negotiated Rate |
$6.07 |
| Rate for Payer: Blue Shield of California Commercial |
$5.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
|
