|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
|
IP
|
$229.96
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: United Healthcare HMO Rider |
$82.19
|
| Rate for Payer: Adventist Health Commercial |
$45.99
|
| Rate for Payer: Blue Shield of California Commercial |
$116.59
|
| Rate for Payer: Blue Shield of California Commercial |
$176.84
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cigna of CA HMO |
$160.97
|
| Rate for Payer: Cigna of CA PPO |
$160.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.98
|
| Rate for Payer: EPIC Health Plan Senior |
$91.98
|
| Rate for Payer: Galaxy Health WC |
$195.47
|
| Rate for Payer: Global Benefits Group Commercial |
$137.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$183.97
|
| Rate for Payer: Networks By Design Commercial |
$114.98
|
| Rate for Payer: Prime Health Services Commercial |
$195.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.30
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.31
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
|
OP
|
$229.96
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Adventist Health Commercial |
$45.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cigna of CA HMO |
$160.97
|
| Rate for Payer: Cigna of CA PPO |
$160.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: Galaxy Health WC |
$195.47
|
| Rate for Payer: Global Benefits Group Commercial |
$137.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.45
|
| Rate for Payer: Multiplan Commercial |
$183.97
|
| Rate for Payer: Networks By Design Commercial |
$114.98
|
| Rate for Payer: Prime Health Services Commercial |
$195.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.30
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$82.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.04
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna of CA HMO |
$14.55
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$22.34
|
| Rate for Payer: Cigna of CA HMO |
$28.11
|
| Rate for Payer: Cigna of CA PPO |
$22.34
|
| Rate for Payer: Cigna of CA PPO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$28.11
|
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.03
|
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.77
|
| Rate for Payer: EPIC Health Plan Senior |
$12.77
|
| Rate for Payer: EPIC Health Plan Senior |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$27.13
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Galaxy Health WC |
$34.13
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$24.09
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Global Benefits Group Commercial |
$19.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$32.12
|
| Rate for Payer: Networks By Design Commercial |
$20.07
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Networks By Design Commercial |
$15.96
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$27.13
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Prime Health Services Commercial |
$34.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$14.67
|
| Rate for Payer: United Healthcare All Other HMO |
$7.59
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$34.13
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$27.13
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Galaxy Health WC |
$34.13
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Galaxy Health WC |
$27.13
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.03
|
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Blue Shield of California Commercial |
$24.55
|
| Rate for Payer: Blue Shield of California Commercial |
$10.54
|
| Rate for Payer: Blue Shield of California Commercial |
$20.36
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Blue Shield of California Commercial |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$15.98
|
| Rate for Payer: Blue Shield of California Commercial |
$16.18
|
| Rate for Payer: Blue Shield of California Commercial |
$30.88
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna of CA HMO |
$22.34
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$14.55
|
| Rate for Payer: Cigna of CA HMO |
$28.11
|
| Rate for Payer: Cigna of CA PPO |
$28.11
|
| Rate for Payer: Cigna of CA PPO |
$22.34
|
| Rate for Payer: Cigna of CA PPO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Global Benefits Group Commercial |
$19.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$24.09
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: Multiplan Commercial |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$32.12
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$15.96
|
| Rate for Payer: Networks By Design Commercial |
$20.07
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Prime Health Services Commercial |
$27.13
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Prime Health Services Commercial |
$34.13
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.07
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare All Other HMO |
$14.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7.59
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare HMO Rider |
$11.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1.56
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.56
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.37
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$1.42
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$1.42
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$0.73
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
|
CEFTRIAXONE 2 GRAM INJECTION (IM) [4080783]
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
|
|
CEFTRIAXONE 2 GRAM INJECTION (IM) [4080783]
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2.95
|
|
|
CEFTRIAXONE 2 GRAM INTRAVENOUS SOLUTION [27309]
|
Facility
|
IP
|
$9.57
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Adventist Health Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.85
|
| Rate for Payer: Blue Shield of California Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO |
$6.70
|
| Rate for Payer: Cigna of CA PPO |
$6.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.83
|
| Rate for Payer: EPIC Health Plan Senior |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$8.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.66
|
| Rate for Payer: Networks By Design Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
|
|
CEFTRIAXONE 2 GRAM INTRAVENOUS SOLUTION [27309]
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Adventist Health Commercial |
$1.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO |
$6.70
|
| Rate for Payer: Cigna of CA PPO |
$6.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.83
|
| Rate for Payer: EPIC Health Plan Senior |
$3.83
|
| Rate for Payer: Galaxy Health WC |
$8.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$7.66
|
| Rate for Payer: Networks By Design Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$8.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.59
|
| Rate for Payer: United Healthcare All Other HMO |
$3.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.13
|
| Rate for Payer: Vantage Medical Group Senior |
$8.13
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$4.75
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$6.55
|
| Rate for Payer: Cigna of CA PPO |
$5.62
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$6.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$3.21
|
| Rate for Payer: EPIC Health Plan Senior |
$3.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$7.96
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$3.35
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
|
|
CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION [9488]
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$2.78
|
| Rate for Payer: Networks By Design Commercial |
$1.74
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$4.68
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Adventist Health Commercial |
$1.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$6.55
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.62
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Cigna of CA PPO |
$6.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$3.74
|
| Rate for Payer: EPIC Health Plan Senior |
$3.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.39
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Galaxy Health WC |
$7.96
|
| Rate for Payer: Galaxy Health WC |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.55
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$7.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$2.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO |
$3.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.96
|
| Rate for Payer: Vantage Medical Group Senior |
$7.96
|
| Rate for Payer: Vantage Medical Group Senior |
$2.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
CEFTRIAXONE 500 MG INJECTION (IM) [4080778]
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
|
|
CEFTRIAXONE 500 MG INJECTION (IM) [4080778]
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Adventist Health Commercial |
$0.23
|
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$0.86
|
| Rate for Payer: EPIC Health Plan Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.99
|
| Rate for Payer: United Healthcare All Other HMO |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO |
$0.79
|
| Rate for Payer: United Healthcare HMO Rider |
$0.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.71
|
|
