|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
OP
|
$8.04
|
|
|
Service Code
|
NDC 43598-020-28
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.79
|
| Rate for Payer: BCBS Transplant Transplant |
$4.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.70
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO |
$5.63
|
| Rate for Payer: Cigna of CA PPO |
$5.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Media |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.43
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
IP
|
$52.44
|
|
|
Service Code
|
CPT J0285
|
| Hospital Charge Code |
1757256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$44.57 |
| Rate for Payer: Blue Shield of California Commercial |
$37.34
|
| Rate for Payer: Blue Shield of California EPN |
$26.85
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cigna of CA HMO |
$36.71
|
| Rate for Payer: Cigna of CA PPO |
$36.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.98
|
| Rate for Payer: Galaxy Health WC |
$44.57
|
| Rate for Payer: Global Benefits Group Commercial |
$31.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$41.95
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Prime Health Services Commercial |
$44.57
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
OP
|
$52.44
|
|
|
Service Code
|
CPT J0285
|
| Hospital Charge Code |
1757256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$59.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.12
|
| Rate for Payer: BCBS Transplant Transplant |
$31.46
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$52.44
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cigna of CA HMO |
$36.71
|
| Rate for Payer: Cigna of CA PPO |
$36.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.57
|
| Rate for Payer: Dignity Health Media |
$44.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.98
|
| Rate for Payer: Galaxy Health WC |
$44.57
|
| Rate for Payer: Global Benefits Group Commercial |
$31.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$41.95
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Prime Health Services Commercial |
$44.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.22
|
| Rate for Payer: United Healthcare All Other HMO |
$26.22
|
| Rate for Payer: United Healthcare HMO Rider |
$26.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.57
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
OP
|
$360.05
|
|
|
Service Code
|
NDC 0469-3051-30
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.41 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$236.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$306.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$198.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$198.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.52
|
| Rate for Payer: BCBS Transplant Transplant |
$216.03
|
| Rate for Payer: Blue Shield of California Commercial |
$265.36
|
| Rate for Payer: Blue Shield of California EPN |
$210.27
|
| Rate for Payer: Cash Price |
$162.02
|
| Rate for Payer: Cash Price |
$162.02
|
| Rate for Payer: Cigna of CA HMO |
$252.04
|
| Rate for Payer: Cigna of CA PPO |
$252.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.04
|
| Rate for Payer: Dignity Health Media |
$306.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.02
|
| Rate for Payer: Galaxy Health WC |
$306.04
|
| Rate for Payer: Global Benefits Group Commercial |
$216.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$270.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.41
|
| Rate for Payer: Multiplan Commercial |
$288.04
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$306.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.02
|
| Rate for Payer: United Healthcare All Other HMO |
$180.02
|
| Rate for Payer: United Healthcare HMO Rider |
$180.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.04
|
| Rate for Payer: Vantage Medical Group Senior |
$306.04
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
IP
|
$360.05
|
|
|
Service Code
|
NDC 0469-3051-30
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.41 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Blue Shield of California Commercial |
$256.36
|
| Rate for Payer: Blue Shield of California EPN |
$184.35
|
| Rate for Payer: Cash Price |
$162.02
|
| Rate for Payer: Cigna of CA HMO |
$252.04
|
| Rate for Payer: Cigna of CA PPO |
$252.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.02
|
| Rate for Payer: Galaxy Health WC |
$306.04
|
| Rate for Payer: Global Benefits Group Commercial |
$216.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.41
|
| Rate for Payer: Multiplan Commercial |
$288.04
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$306.04
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
IP
|
$305.70
|
|
|
Service Code
|
NDC 55150-365-01
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$259.84 |
| Rate for Payer: Blue Shield of California Commercial |
$217.66
|
| Rate for Payer: Blue Shield of California EPN |
$156.52
|
| Rate for Payer: Cash Price |
$137.57
|
| Rate for Payer: Cigna of CA HMO |
$213.99
|
| Rate for Payer: Cigna of CA PPO |
$213.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.28
|
| Rate for Payer: Galaxy Health WC |
$259.84
|
| Rate for Payer: Global Benefits Group Commercial |
$183.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.37
|
| Rate for Payer: Multiplan Commercial |
$244.56
|
| Rate for Payer: Networks By Design Commercial |
$152.85
|
| Rate for Payer: Prime Health Services Commercial |
$259.84
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
OP
|
$305.70
|
|
|
Service Code
|
NDC 55150-365-01
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$259.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$200.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.14
|
| Rate for Payer: BCBS Transplant Transplant |
$183.42
|
| Rate for Payer: Blue Shield of California Commercial |
$225.30
|
| Rate for Payer: Blue Shield of California EPN |
$178.53
|
| Rate for Payer: Cash Price |
$137.57
|
| Rate for Payer: Cash Price |
$137.57
|
| Rate for Payer: Cigna of CA HMO |
$213.99
|
| Rate for Payer: Cigna of CA PPO |
$213.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.84
|
| Rate for Payer: Dignity Health Media |
$259.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.28
|
| Rate for Payer: Galaxy Health WC |
$259.84
|
| Rate for Payer: Global Benefits Group Commercial |
$183.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$229.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.37
|
| Rate for Payer: Multiplan Commercial |
$244.56
|
| Rate for Payer: Networks By Design Commercial |
$152.85
|
| Rate for Payer: Prime Health Services Commercial |
$259.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.85
|
| Rate for Payer: United Healthcare All Other HMO |
$152.85
|
| Rate for Payer: United Healthcare HMO Rider |
$152.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.84
|
| Rate for Payer: Vantage Medical Group Senior |
$259.84
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
IP
|
$4.56
|
|
|
Service Code
|
NDC 9994-0802-41
|
| Hospital Charge Code |
1715157
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.65
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
OP
|
$4.56
|
|
|
Service Code
|
NDC 9994-0802-41
|
| Hospital Charge Code |
1715157
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: BCBS Transplant Transplant |
$2.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California EPN |
$2.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Media |
$3.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$3.65
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1752200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Blue Shield of California Commercial |
$55.54
|
| Rate for Payer: Blue Shield of California Commercial |
$64.08
|
| Rate for Payer: Blue Shield of California Commercial |
$58.93
|
| Rate for Payer: Blue Shield of California EPN |
$39.94
|
| Rate for Payer: Blue Shield of California EPN |
$46.08
|
| Rate for Payer: Blue Shield of California EPN |
$42.38
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$57.94
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$57.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.11
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$70.35
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$49.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$66.22
|
| Rate for Payer: Networks By Design Commercial |
$41.38
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$70.35
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1752200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$46.80
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: BCBS Transplant Transplant |
$49.66
|
| Rate for Payer: Blue Shield of California Commercial |
$57.49
|
| Rate for Payer: Blue Shield of California Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$66.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$57.94
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Media |
$76.50
|
| Rate for Payer: Dignity Health Media |
$66.30
|
| Rate for Payer: Dignity Health Media |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.11
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$70.35
|
| Rate for Payer: Global Benefits Group Commercial |
$49.66
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$62.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$66.22
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$41.38
|
| Rate for Payer: Prime Health Services Commercial |
$70.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.38
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.38
|
| Rate for Payer: United Healthcare All Other HMO |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.35
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
OP
|
$5.81
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$3.98
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: BCBS Transplant Transplant |
$3.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5.31
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA HMO |
$4.07
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.07
|
| Rate for Payer: Cigna of CA PPO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Media |
$5.64
|
| Rate for Payer: Dignity Health Media |
$4.94
|
| Rate for Payer: Dignity Health Media |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.32
|
| Rate for Payer: Galaxy Health WC |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$4.65
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.32
|
| Rate for Payer: United Healthcare All Other HMO |
$2.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.32
|
| Rate for Payer: United Healthcare HMO Rider |
$2.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.64
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
IP
|
$6.63
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Multiplan Commercial |
$5.76
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Networks By Design Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.39
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA HMO |
$4.07
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$4.07
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.94
|
| Rate for Payer: Prime Health Services Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]
|
Facility
OP
|
$2.22
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: BCBS Transplant Transplant |
$1.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Media |
$1.88
|
| Rate for Payer: Dignity Health Media |
$2.04
|
| Rate for Payer: Dignity Health Media |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.66
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Networks By Design Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]
|
Facility
IP
|
$2.22
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.13
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$1.88
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$1.92
|
| Rate for Payer: Networks By Design Commercial |
$1.10
|
| Rate for Payer: Networks By Design Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$1.88
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
OP
|
$8.53
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$5.12
|
| Rate for Payer: BCBS Transplant Transplant |
$9.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Media |
$7.25
|
| Rate for Payer: Dignity Health Media |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.04
|
| Rate for Payer: United Healthcare All Other HMO |
$8.04
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
IP
|
$16.08
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Blue Shield of California Commercial |
$11.45
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$4.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.23
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
1710493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
1710493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: BCBS Transplant Transplant |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Media |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
OP
|
$2.84
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$1.70
|
| Rate for Payer: BCBS Transplant Transplant |
$2.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$3.12
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$2.37
|
| Rate for Payer: Cigna of CA HMO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$1.99
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$2.41
|
| Rate for Payer: Dignity Health Media |
$2.87
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$2.87
|
| Rate for Payer: Galaxy Health WC |
$2.41
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Networks By Design Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$2.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.41
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
OP
|
$66.60
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$56.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$48.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: BCBS Transplant Transplant |
$52.42
|
| Rate for Payer: BCBS Transplant Transplant |
$39.96
|
| Rate for Payer: Blue Shield of California Commercial |
$49.08
|
| Rate for Payer: Blue Shield of California Commercial |
$64.39
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA HMO |
$46.62
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.26
|
| Rate for Payer: Dignity Health Media |
$74.26
|
| Rate for Payer: Dignity Health Media |
$56.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.64
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Galaxy Health WC |
$56.61
|
| Rate for Payer: Global Benefits Group Commercial |
$39.96
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$49.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$69.90
|
| Rate for Payer: Multiplan Commercial |
$53.28
|
| Rate for Payer: Networks By Design Commercial |
$43.68
|
| Rate for Payer: Networks By Design Commercial |
$33.30
|
| Rate for Payer: Prime Health Services Commercial |
$56.61
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.68
|
| Rate for Payer: United Healthcare All Other HMO |
$33.30
|
| Rate for Payer: United Healthcare All Other HMO |
$43.68
|
| Rate for Payer: United Healthcare HMO Rider |
$33.30
|
| Rate for Payer: United Healthcare HMO Rider |
$43.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.61
|
| Rate for Payer: Vantage Medical Group Senior |
$56.61
|
| Rate for Payer: Vantage Medical Group Senior |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION [32469]
|
Facility
IP
|
$87.37
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Blue Shield of California Commercial |
$62.21
|
| Rate for Payer: Blue Shield of California Commercial |
$47.42
|
| Rate for Payer: Blue Shield of California EPN |
$34.10
|
| Rate for Payer: Blue Shield of California EPN |
$44.73
|
| Rate for Payer: Cash Price |
$29.97
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Cigna of CA HMO |
$46.62
|
| Rate for Payer: Cigna of CA HMO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$61.16
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.64
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Galaxy Health WC |
$56.61
|
| Rate for Payer: Global Benefits Group Commercial |
$39.96
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$69.90
|
| Rate for Payer: Multiplan Commercial |
$53.28
|
| Rate for Payer: Networks By Design Commercial |
$33.30
|
| Rate for Payer: Networks By Design Commercial |
$43.68
|
| Rate for Payer: Prime Health Services Commercial |
$56.61
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [32470]
|
Facility
IP
|
$9.25
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Blue Shield of California Commercial |
$6.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Blue Shield of California EPN |
$4.74
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$3.27
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.29
|
| Rate for Payer: Cigna of CA PPO |
$3.27
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.87
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$7.86
|
| Rate for Payer: Global Benefits Group Commercial |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Global Benefits Group Commercial |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.78
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION [32470]
|
Facility
OP
|
$3.27
|
|
|
Service Code
|
CPT J0295
|
| Hospital Charge Code |
ERX32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: BCBS Transplant Transplant |
$1.96
|
| Rate for Payer: BCBS Transplant Transplant |
$3.96
|
| Rate for Payer: BCBS Transplant Transplant |
$5.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cigna of CA HMO |
$3.27
|
| Rate for Payer: Cigna of CA HMO |
$2.29
|
| Rate for Payer: Cigna of CA HMO |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$2.29
|
| Rate for Payer: Cigna of CA PPO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$3.27
|
| Rate for Payer: Cigna of CA PPO |
$6.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.78
|
| Rate for Payer: Dignity Health Media |
$2.78
|
| Rate for Payer: Dignity Health Media |
$5.61
|
| Rate for Payer: Dignity Health Media |
$3.97
|
| Rate for Payer: Dignity Health Media |
$7.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.64
|
| Rate for Payer: Galaxy Health WC |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$2.78
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$7.86
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$3.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.58
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Networks By Design Commercial |
$4.62
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.78
|
| Rate for Payer: Prime Health Services Commercial |
$5.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$3.30
|
| Rate for Payer: United Healthcare HMO Rider |
$2.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$4.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$7.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.97
|
|
