|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Galaxy Health WC |
$70.35
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$49.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.22
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$41.38
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$70.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$28.49
|
| Rate for Payer: United Healthcare All Other HMO |
$30.24
|
| Rate for Payer: United Healthcare HMO Rider |
$29.58
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare HMO Rider |
$27.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.08
|
| Rate for Payer: Blue Shield of California Commercial |
$66.42
|
| Rate for Payer: Blue Shield of California Commercial |
$57.56
|
| Rate for Payer: Blue Shield of California EPN |
$40.23
|
| Rate for Payer: Blue Shield of California EPN |
$37.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.74
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$57.94
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
| Rate for Payer: Galaxy Health WC |
$70.35
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$49.66
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.94
|
| Rate for Payer: Multiplan Commercial |
$66.22
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$41.38
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$70.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$30.24
|
| Rate for Payer: United Healthcare All Other HMO |
$28.49
|
| Rate for Payer: United Healthcare HMO Rider |
$27.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare HMO Rider |
$29.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
AMPICILLIN 1G/50ML NS IV ADMIXTURE KIT (ADSOK) [200002]
|
Facility
|
OP
|
$7.08
|
|
|
Service Code
|
NDC 9999-2000-02
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Cigna of CA HMO |
$4.53
|
| Rate for Payer: Cigna of CA PPO |
$5.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2.83
|
| Rate for Payer: Galaxy Health WC |
$6.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$4.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO |
$3.54
|
| Rate for Payer: United Healthcare HMO Rider |
$3.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.02
|
| Rate for Payer: Vantage Medical Group Senior |
$6.02
|
|
|
AMPICILLIN 1G/50ML NS IV ADMIXTURE KIT (ADSOK) [200002]
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
NDC 9999-2000-02
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Adventist Health Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2.83
|
| Rate for Payer: Galaxy Health WC |
$6.02
|
| Rate for Payer: Global Benefits Group Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.70
|
| Rate for Payer: Multiplan Commercial |
$5.66
|
| Rate for Payer: Networks By Design Commercial |
$4.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.02
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA HMO |
$4.07
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$4.07
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.32
|
| Rate for Payer: EPIC Health Plan Senior |
$2.65
|
| Rate for Payer: Galaxy Health WC |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Prime Health Services Commercial |
$4.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| 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 All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.07
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$4.07
|
| Rate for Payer: Cigna of CA PPO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.32
|
| Rate for Payer: EPIC Health Plan Senior |
$2.65
|
| Rate for Payer: Galaxy Health WC |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$4.94
|
| Rate for Payer: Global Benefits Group Commercial |
$3.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$4.65
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2.08
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
IP
|
$16.08
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.87
|
| Rate for Payer: Blue Shield of California EPN |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.81
|
| Rate for Payer: Blue Shield of California EPN |
$4.15
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.05
|
| Rate for Payer: United Healthcare HMO Rider |
$5.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
OP
|
$8.53
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5.75
|
| Rate for Payer: United Healthcare HMO Rider |
$3.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.30
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.43
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Senior |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cash Price |
$1.86
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
IP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Blue Shield of California Commercial |
$64.48
|
| Rate for Payer: Blue Shield of California EPN |
$42.46
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Senior |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$69.90
|
| Rate for Payer: Networks By Design Commercial |
$43.69
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$31.92
|
| Rate for Payer: United Healthcare HMO Rider |
$31.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.61
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
|
OP
|
$87.37
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cash Price |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Senior |
$34.95
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.16
|
| Rate for Payer: Multiplan Commercial |
$69.90
|
| Rate for Payer: Networks By Design Commercial |
$43.69
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.79
|
| Rate for Payer: United Healthcare All Other HMO |
$31.92
|
| Rate for Payer: United Healthcare HMO Rider |
$31.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 3 G/100 ML IN NS [400006]
|
Facility
|
OP
|
$86.08
|
|
|
Service Code
|
NDC 9940-8203-96
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$73.17 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.86
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Cigna of CA HMO |
$55.09
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.43
|
| Rate for Payer: EPIC Health Plan Senior |
$34.43
|
| Rate for Payer: Galaxy Health WC |
$73.17
|
| Rate for Payer: Global Benefits Group Commercial |
$51.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.26
|
| Rate for Payer: Multiplan Commercial |
$68.86
|
| Rate for Payer: Networks By Design Commercial |
$55.95
|
| Rate for Payer: Prime Health Services Commercial |
$73.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.04
|
| Rate for Payer: United Healthcare HMO Rider |
$43.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.17
|
| Rate for Payer: Vantage Medical Group Senior |
$73.17
|
|
|
AMPICILLIN-SULBACTAM 3 G/100 ML IN NS [400006]
|
Facility
|
IP
|
$86.08
|
|
|
Service Code
|
NDC 9940-8203-96
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$73.17 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.43
|
| Rate for Payer: EPIC Health Plan Senior |
$34.43
|
| Rate for Payer: Galaxy Health WC |
$73.17
|
| Rate for Payer: Global Benefits Group Commercial |
$51.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.66
|
| Rate for Payer: Multiplan Commercial |
$68.86
|
| Rate for Payer: Networks By Design Commercial |
$55.95
|
| Rate for Payer: Prime Health Services Commercial |
$73.17
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$11.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| 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 |
$3.53
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$8.73
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION [32471]
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4.75
|
| Rate for Payer: Blue Shield of California Commercial |
$12.89
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$8.49
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA HMO |
$4.50
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.57
|
| Rate for Payer: EPIC Health Plan Senior |
$2.57
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Galaxy Health WC |
$5.47
|
| Rate for Payer: Global Benefits Group Commercial |
$3.86
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Multiplan Commercial |
$5.09
|
| Rate for Payer: Multiplan Commercial |
$5.14
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Networks By Design Commercial |
$3.21
|
| Rate for Payer: Networks By Design Commercial |
$8.73
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Prime Health Services Commercial |
$5.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2.35
|
| Rate for Payer: United Healthcare All Other HMO |
$6.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$377.35
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$320.75 |
| Rate for Payer: Adventist Health Commercial |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$278.48
|
| Rate for Payer: Blue Shield of California EPN |
$183.39
|
| Rate for Payer: Cash Price |
$207.54
|
| Rate for Payer: Cigna of CA HMO |
$264.14
|
| Rate for Payer: Cigna of CA PPO |
$264.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.94
|
| Rate for Payer: EPIC Health Plan Senior |
$150.94
|
| Rate for Payer: Galaxy Health WC |
$320.75
|
| Rate for Payer: Global Benefits Group Commercial |
$226.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.56
|
| Rate for Payer: Multiplan Commercial |
$301.88
|
| Rate for Payer: Networks By Design Commercial |
$188.68
|
| Rate for Payer: Prime Health Services Commercial |
$320.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.62
|
| Rate for Payer: United Healthcare All Other HMO |
$137.85
|
| Rate for Payer: United Healthcare HMO Rider |
$134.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.58
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$377.35
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$320.75 |
| Rate for Payer: Adventist Health Commercial |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.73
|
| Rate for Payer: Cash Price |
$207.54
|
| Rate for Payer: Cigna of CA HMO |
$264.14
|
| Rate for Payer: Cigna of CA PPO |
$264.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.94
|
| Rate for Payer: EPIC Health Plan Senior |
$150.94
|
| Rate for Payer: Galaxy Health WC |
$320.75
|
| Rate for Payer: Global Benefits Group Commercial |
$226.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.14
|
| Rate for Payer: Multiplan Commercial |
$301.88
|
| Rate for Payer: Networks By Design Commercial |
$188.68
|
| Rate for Payer: Prime Health Services Commercial |
$320.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.62
|
| Rate for Payer: United Healthcare All Other HMO |
$137.85
|
| Rate for Payer: United Healthcare HMO Rider |
$134.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.75
|
| Rate for Payer: Vantage Medical Group Senior |
$320.75
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.09
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS S0170
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
|
IP
|
$229.07
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Blue Shield of California Commercial |
$169.05
|
| Rate for Payer: Blue Shield of California EPN |
$111.33
|
| Rate for Payer: Cash Price |
$125.99
|
| Rate for Payer: Cigna of CA HMO |
$160.35
|
| Rate for Payer: Cigna of CA PPO |
$160.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.63
|
| Rate for Payer: EPIC Health Plan Senior |
$91.63
|
| Rate for Payer: Galaxy Health WC |
$194.71
|
| Rate for Payer: Global Benefits Group Commercial |
$137.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$183.26
|
| Rate for Payer: Networks By Design Commercial |
$114.53
|
| Rate for Payer: Prime Health Services Commercial |
$194.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.97
|
| Rate for Payer: United Healthcare All Other HMO |
$83.68
|
| Rate for Payer: United Healthcare HMO Rider |
$81.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.02
|
|
