|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 65862-641-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 50111-787-51
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.84
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 50111-787-10
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$1.78
|
| Rate for Payer: Cigna of CA PPO |
$1.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Senior |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.17
|
| Rate for Payer: Global Benefits Group Commercial |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$2.04
|
| Rate for Payer: Networks By Design Commercial |
$1.66
|
| Rate for Payer: Prime Health Services Commercial |
$2.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 59762-2198-7
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
IP
|
$5.64
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Blue Shield of California EPN |
$2.74
|
| Rate for Payer: Blue Shield of California EPN |
$3.62
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$3.95
|
| Rate for Payer: Cigna of CA HMO |
$5.21
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$3.95
|
| Rate for Payer: Cigna of CA PPO |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$4.51
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$5.95
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other HMO |
$2.72
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Galaxy Health WC |
$4.79
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$4.51
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.72
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.02
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.51
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.20
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cigna of CA HMO |
$5.21
|
| Rate for Payer: Cigna of CA HMO |
$3.95
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$3.95
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$5.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 65862-642-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.30 |
| 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 Permanente of CA Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| 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: Cigna of CA HMO |
$1.07
|
| Rate for Payer: Cigna of CA PPO |
$1.07
|
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.84
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 68180-862-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 0069-3070-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.19
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$2.50
|
| Rate for Payer: Cigna of CA PPO |
$2.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.03
|
| Rate for Payer: Vantage Medical Group Senior |
$3.03
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 0069-3070-30
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$2.50
|
| Rate for Payer: Cigna of CA PPO |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$2.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.03
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 68180-862-06
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.30
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.80
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 65862-642-30
|
| 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 |
$0.94
|
| Rate for Payer: Cash Price |
$0.84
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.95
|
| 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
|
|
|
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: 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 |
$22.32
|
| Rate for Payer: Blue Shield of California Commercial |
$31.96
|
| Rate for Payer: Blue Shield of California Commercial |
$30.10
|
| Rate for Payer: Blue Shield of California Commercial |
$26.32
|
| Rate for Payer: Blue Shield of California EPN |
$14.70
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.82
|
| Rate for Payer: Blue Shield of California EPN |
$21.04
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$19.62
|
| Rate for Payer: Cigna of CA HMO |
$21.17
|
| 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 |
$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: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| 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 |
$16.32
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$25.70
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Galaxy Health WC |
$34.67
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| 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: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.80
|
| 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 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 |
$2.48 |
| 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 |
$26.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.40
|
| 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 |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.68
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| 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: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$19.62
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$19.62
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cigna of CA HMO |
$21.17
|
| 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 |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| 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 |
$28.55
|
| 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 |
$34.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$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 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: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| 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 |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$16.32
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| 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 |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.25
|
| 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 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 |
$52.65
|
| Rate for Payer: Blue Shield of California Commercial |
$59.29
|
| Rate for Payer: Blue Shield of California Commercial |
$50.66
|
| Rate for Payer: Blue Shield of California EPN |
$34.67
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Blue Shield of California EPN |
$39.05
|
| Rate for Payer: Cash Price |
$39.24
|
| Rate for Payer: Cash Price |
$37.75
|
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$56.24
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| 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 |
$58.34
|
| Rate for Payer: Galaxy Health WC |
$68.29
|
| Rate for Payer: Global Benefits Group Commercial |
$48.20
|
| Rate for Payer: Global Benefits Group Commercial |
$41.18
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.73
|
| 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
|
$80.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$68.29 |
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.19
|
| 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 Medicare Advantage/Dual Product |
$51.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| 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 EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Cash Price |
$37.75
|
| Rate for Payer: Cash Price |
$39.24
|
| Rate for Payer: Cash Price |
$37.75
|
| Rate for Payer: Cash Price |
$39.24
|
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Cigna of CA HMO |
$56.24
|
| Rate for Payer: Cigna of CA HMO |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$48.05
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.34
|
| 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 |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.16
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.34
|
| 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
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
IP
|
$181.28
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$154.09 |
| Rate for Payer: Adventist Health Commercial |
$36.26
|
| Rate for Payer: Blue Shield of California Commercial |
$133.78
|
| Rate for Payer: Blue Shield of California EPN |
$88.10
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cigna of CA HMO |
$126.90
|
| Rate for Payer: Cigna of CA PPO |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.51
|
| Rate for Payer: EPIC Health Plan Senior |
$72.51
|
| Rate for Payer: Galaxy Health WC |
$154.09
|
| Rate for Payer: Global Benefits Group Commercial |
$108.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.51
|
| Rate for Payer: Multiplan Commercial |
$145.02
|
| Rate for Payer: Networks By Design Commercial |
$117.83
|
| Rate for Payer: Prime Health Services Commercial |
$154.09
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
OP
|
$181.28
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$154.09 |
| Rate for Payer: Adventist Health Commercial |
$36.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.32
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cigna of CA HMO |
$126.90
|
| Rate for Payer: Cigna of CA PPO |
$126.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.51
|
| Rate for Payer: EPIC Health Plan Senior |
$72.51
|
| Rate for Payer: Galaxy Health WC |
$154.09
|
| Rate for Payer: Global Benefits Group Commercial |
$108.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.90
|
| Rate for Payer: Multiplan Commercial |
$145.02
|
| Rate for Payer: Networks By Design Commercial |
$117.83
|
| Rate for Payer: Prime Health Services Commercial |
$154.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.64
|
| Rate for Payer: United Healthcare All Other HMO |
$90.64
|
| Rate for Payer: United Healthcare HMO Rider |
$90.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.09
|
| Rate for Payer: Vantage Medical Group Senior |
$154.09
|
|
|
B221Z2Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2775
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
B223Z2Z
|
Facility
|
IP
|
$12,567.00
|
|
| Hospital Charge Code |
2776
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
|
OP
|
$37.06
|
|
|
Service Code
|
NDC 0574-4022-35
|
| 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 |
$22.76
|
| Rate for Payer: Cash Price |
$20.38
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| 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 0574-4022-35
|
| 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 |
$27.35
|
| Rate for Payer: Blue Shield of California EPN |
$18.01
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cigna of CA HMO |
$25.94
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| 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
|
$0.09
|
|
|
Service Code
|
NDC 0713-0280-31
|
| 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 |
$0.05
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| 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
|
$0.08
|
|
|
Service Code
|
NDC 0536-1256-28
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA 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
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 68001-477-47
|
| 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 |
$0.05
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| 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
|
|
