|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 6586264230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.98
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO |
$1.07
|
| Rate for Payer: Cigna of CA PPO |
$1.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Senior |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Networks By Design Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
IP
|
$5.53
|
|
|
Service Code
|
NDC 6818086306
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Adventist Health Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.87
|
| Rate for Payer: Cigna of CA PPO |
$3.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: EPIC Health Plan Senior |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.70
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
NDC 6818086306
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Adventist Health Commercial |
$1.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.55
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.87
|
| Rate for Payer: Cigna of CA PPO |
$3.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: EPIC Health Plan Senior |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.77
|
| Rate for Payer: United Healthcare All Other HMO |
$2.77
|
| Rate for Payer: United Healthcare HMO Rider |
$2.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.70
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
OP
|
$40.79
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Adventist Health Commercial |
$8.16
|
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cigna of CA HMO |
$21.17
|
| Rate for Payer: Cigna of CA HMO |
$24.97
|
| Rate for Payer: Cigna of CA HMO |
$28.55
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$28.55
|
| Rate for Payer: Cigna of CA PPO |
$21.17
|
| Rate for Payer: Cigna of CA PPO |
$24.97
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Senior |
$16.32
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$34.67
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Galaxy Health WC |
$25.70
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Global Benefits Group Commercial |
$18.14
|
| Rate for Payer: Global Benefits Group Commercial |
$24.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.97
|
| Rate for Payer: Multiplan Commercial |
$28.54
|
| Rate for Payer: Multiplan Commercial |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$32.63
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Networks By Design Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$15.12
|
| Rate for Payer: Networks By Design Commercial |
$20.39
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: Prime Health Services Commercial |
$34.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.70
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$11.05
|
| Rate for Payer: United Healthcare All Other HMO |
$13.03
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$14.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.81
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.32
|
| Rate for Payer: Vantage Medical Group Senior |
$34.67
|
| Rate for Payer: Vantage Medical Group Senior |
$25.70
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
IP
|
$35.67
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$28.55
|
| Rate for Payer: Cigna of CA PPO |
$21.17
|
| Rate for Payer: Cigna of CA PPO |
$24.97
|
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Adventist Health Commercial |
$8.16
|
| Rate for Payer: Blue Shield of California Commercial |
$31.37
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Blue Shield of California Commercial |
$18.08
|
| Rate for Payer: Blue Shield of California Commercial |
$23.25
|
| Rate for Payer: Blue Shield of California Commercial |
$20.68
|
| Rate for Payer: Blue Shield of California Commercial |
$33.30
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cigna of CA HMO |
$28.55
|
| Rate for Payer: Cigna of CA HMO |
$24.97
|
| Rate for Payer: Cigna of CA HMO |
$21.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$25.70
|
| Rate for Payer: Galaxy Health WC |
$34.67
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Global Benefits Group Commercial |
$24.47
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Global Benefits Group Commercial |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Multiplan Commercial |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$32.63
|
| Rate for Payer: Multiplan Commercial |
$28.54
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$20.39
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Networks By Design Commercial |
$15.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.70
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$11.05
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$10.81
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare HMO Rider |
$14.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.36
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
IP
|
$68.64
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$58.34 |
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California Commercial |
$34.80
|
| Rate for Payer: Blue Shield of California Commercial |
$52.78
|
| Rate for Payer: Blue Shield of California Commercial |
$61.78
|
| Rate for Payer: Blue Shield of California Commercial |
$40.73
|
| Rate for Payer: Blue Shield of California Commercial |
$36.17
|
| Rate for Payer: Cash Price |
$36.15
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cigna of CA HMO |
$56.24
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.54
|
| Rate for Payer: EPIC Health Plan Senior |
$27.46
|
| Rate for Payer: EPIC Health Plan Senior |
$32.14
|
| Rate for Payer: Galaxy Health WC |
$68.29
|
| Rate for Payer: Galaxy Health WC |
$58.34
|
| Rate for Payer: Galaxy Health WC |
$60.64
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Global Benefits Group Commercial |
$48.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Multiplan Commercial |
$57.07
|
| Rate for Payer: Multiplan Commercial |
$64.27
|
| Rate for Payer: Networks By Design Commercial |
$35.67
|
| Rate for Payer: Networks By Design Commercial |
$40.17
|
| Rate for Payer: Networks By Design Commercial |
$34.32
|
| Rate for Payer: Prime Health Services Commercial |
$58.34
|
| Rate for Payer: Prime Health Services Commercial |
$60.64
|
| Rate for Payer: Prime Health Services Commercial |
$68.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.15
|
| Rate for Payer: United Healthcare All Other HMO |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO |
$25.07
|
| Rate for Payer: United Healthcare All Other HMO |
$26.06
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.71
|
| Rate for Payer: United Healthcare HMO Rider |
$24.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.36
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
OP
|
$71.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.29
|
| Rate for Payer: Vantage Medical Group Senior |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$68.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$36.15
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$36.15
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cigna of CA HMO |
$56.24
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.14
|
| Rate for Payer: EPIC Health Plan Senior |
$32.14
|
| Rate for Payer: EPIC Health Plan Senior |
$27.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.54
|
| Rate for Payer: Galaxy Health WC |
$60.64
|
| Rate for Payer: Galaxy Health WC |
$68.29
|
| Rate for Payer: Galaxy Health WC |
$58.34
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Global Benefits Group Commercial |
$48.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$57.07
|
| Rate for Payer: Multiplan Commercial |
$64.27
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Networks By Design Commercial |
$40.17
|
| Rate for Payer: Networks By Design Commercial |
$35.67
|
| Rate for Payer: Networks By Design Commercial |
$34.32
|
| Rate for Payer: Prime Health Services Commercial |
$68.29
|
| Rate for Payer: Prime Health Services Commercial |
$58.34
|
| Rate for Payer: Prime Health Services Commercial |
$60.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.76
|
| Rate for Payer: United Healthcare All Other HMO |
$29.35
|
| Rate for Payer: United Healthcare All Other HMO |
$26.06
|
| Rate for Payer: United Healthcare All Other HMO |
$25.07
|
| Rate for Payer: United Healthcare HMO Rider |
$24.53
|
| Rate for Payer: United Healthcare HMO Rider |
$28.71
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.29
|
|
|
AZTREONAM-AVIBACTAM 2 GRAM INTRAVENOUS SOLUTION [245951]
|
Facility
|
OP
|
$412.02
|
|
|
Service Code
|
HCPCS J0458
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$350.22 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.14
|
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Cigna of CA HMO |
$288.41
|
| Rate for Payer: Cigna of CA PPO |
$288.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$288.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1.95
|
| Rate for Payer: Galaxy Health WC |
$350.22
|
| Rate for Payer: Global Benefits Group Commercial |
$247.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$261.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$329.62
|
| Rate for Payer: Networks By Design Commercial |
$206.01
|
| Rate for Payer: Prime Health Services Commercial |
$350.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.63
|
| Rate for Payer: United Healthcare All Other HMO |
$150.51
|
| Rate for Payer: United Healthcare HMO Rider |
$147.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1.77
|
|
|
AZTREONAM-AVIBACTAM 2 GRAM INTRAVENOUS SOLUTION [245951]
|
Facility
|
IP
|
$412.02
|
|
|
Service Code
|
HCPCS J0458
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$350.22 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Blue Shield of California Commercial |
$208.89
|
| Rate for Payer: Blue Shield of California Commercial |
$316.84
|
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Cigna of CA HMO |
$288.41
|
| Rate for Payer: Cigna of CA PPO |
$288.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$288.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.81
|
| Rate for Payer: EPIC Health Plan Senior |
$164.81
|
| Rate for Payer: Galaxy Health WC |
$350.22
|
| Rate for Payer: Global Benefits Group Commercial |
$247.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$261.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.62
|
| Rate for Payer: Networks By Design Commercial |
$206.01
|
| Rate for Payer: Prime Health Services Commercial |
$350.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.63
|
| Rate for Payer: United Healthcare All Other HMO |
$150.51
|
| Rate for Payer: United Healthcare HMO Rider |
$147.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.94
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
IP
|
$191.98
|
|
|
Service Code
|
NDC 6195809011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$163.18 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$147.63
|
| Rate for Payer: Blue Shield of California Commercial |
$97.33
|
| Rate for Payer: Cash Price |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$134.39
|
| Rate for Payer: Cigna of CA PPO |
$134.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.79
|
| Rate for Payer: EPIC Health Plan Senior |
$76.79
|
| Rate for Payer: Galaxy Health WC |
$163.18
|
| Rate for Payer: Global Benefits Group Commercial |
$115.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Multiplan Commercial |
$153.58
|
| Rate for Payer: Networks By Design Commercial |
$124.79
|
| Rate for Payer: Prime Health Services Commercial |
$163.18
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
OP
|
$191.98
|
|
|
Service Code
|
NDC 6195809011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$163.18 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.19
|
| Rate for Payer: Cash Price |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$134.39
|
| Rate for Payer: Cigna of CA PPO |
$134.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.79
|
| Rate for Payer: EPIC Health Plan Senior |
$76.79
|
| Rate for Payer: Galaxy Health WC |
$163.18
|
| Rate for Payer: Global Benefits Group Commercial |
$115.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.39
|
| Rate for Payer: Multiplan Commercial |
$153.58
|
| Rate for Payer: Networks By Design Commercial |
$124.79
|
| Rate for Payer: Prime Health Services Commercial |
$163.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.99
|
| Rate for Payer: United Healthcare All Other HMO |
$95.99
|
| Rate for Payer: United Healthcare HMO Rider |
$95.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.18
|
| Rate for Payer: Vantage Medical Group Senior |
$163.18
|
|
|
B221Z2Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD B221Z2Z
|
| Hospital Charge Code |
2775
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
B223Z2Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD B223Z2Z
|
| Hospital Charge Code |
2776
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
|
OP
|
$37.06
|
|
|
Service Code
|
NDC 0574402235
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.78
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Cigna of CA HMO |
$25.94
|
| Rate for Payer: Cigna of CA PPO |
$25.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Senior |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$31.50
|
| Rate for Payer: Global Benefits Group Commercial |
$22.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.94
|
| Rate for Payer: Multiplan Commercial |
$29.65
|
| Rate for Payer: Networks By Design Commercial |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$31.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.53
|
| Rate for Payer: United Healthcare All Other HMO |
$18.53
|
| Rate for Payer: United Healthcare HMO Rider |
$18.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.50
|
| Rate for Payer: Vantage Medical Group Senior |
$31.50
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
|
IP
|
$37.06
|
|
|
Service Code
|
NDC 0574402235
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.79
|
| Rate for Payer: Blue Shield of California Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Cigna of CA HMO |
$25.94
|
| Rate for Payer: Cigna of CA PPO |
$25.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Senior |
$14.82
|
| Rate for Payer: Galaxy Health WC |
$31.50
|
| Rate for Payer: Global Benefits Group Commercial |
$22.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$29.65
|
| Rate for Payer: Networks By Design Commercial |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$31.50
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 4580206003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0536125628
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 4580206001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0536125628
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 6800147747
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 4580206001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0713028031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Vantage Medical Group Senior |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 6800147747
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 4580206003
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0713028031
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.08
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.07
|
| Rate for Payer: Networks By Design Commercial |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.08
|
|
