|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$2.53
|
|
|
Service Code
|
NDC 51224-022-30
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.51
|
| Rate for Payer: Blue Distinction Transplant |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.86
|
| Rate for Payer: Blue Shield of California EPN |
$1.48
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO |
$1.77
|
| Rate for Payer: Cigna of CA PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.15
|
| Rate for Payer: Dignity Health Media |
$2.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.01
|
| Rate for Payer: Galaxy Health WC |
$2.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Networks By Design Commercial |
$1.64
|
| Rate for Payer: Prime Health Services Commercial |
$2.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Other HMO |
$1.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2.15
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 65862-641-30
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Distinction Transplant |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Media |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 59762-2198-7
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.19
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 60687-282-11
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.06
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Cigna of CA HMO |
$1.46
|
| Rate for Payer: Cigna of CA PPO |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Galaxy Health WC |
$1.77
|
| Rate for Payer: Global Benefits Group Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Networks By Design Commercial |
$1.35
|
| Rate for Payer: Prime Health Services Commercial |
$1.77
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 0781-8089-26
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.55
|
| Rate for Payer: Blue Distinction Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Media |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
1753436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$46.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.83
|
| Rate for Payer: Blue Distinction Transplant |
$4.46
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Distinction Transplant |
$3.38
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$5.21
|
| Rate for Payer: Cigna of CA HMO |
$3.95
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$5.21
|
| Rate for Payer: Cigna of CA PPO |
$3.95
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Media |
$4.79
|
| Rate for Payer: Dignity Health Media |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Galaxy Health WC |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$4.51
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3.72
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4.79
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
IP
|
$5.64
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
1753436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Blue Shield of California Commercial |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Blue Shield of California EPN |
$2.89
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cigna of CA HMO |
$5.21
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$3.95
|
| Rate for Payer: Cigna of CA PPO |
$3.95
|
| Rate for Payer: Cigna of CA PPO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Galaxy Health WC |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$6.32
|
| Rate for Payer: Global Benefits Group Commercial |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.38
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$4.51
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$5.95
|
| Rate for Payer: Networks By Design Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.82
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$4.79
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.13
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO |
$2.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2.68
|
| Rate for Payer: United Healthcare HMO Rider |
$2.03
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-21
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.25
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-11
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Blue Shield of California Commercial |
$3.13
|
| Rate for Payer: Blue Shield of California EPN |
$2.25
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-11
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: Blue Distinction Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Media |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-21
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.62
|
| Rate for Payer: Blue Distinction Transplant |
$2.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$3.08
|
| Rate for Payer: Cigna of CA PPO |
$3.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Media |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.76
|
| Rate for Payer: Galaxy Health WC |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.52
|
| Rate for Payer: Networks By Design Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.20
|
| Rate for Payer: United Healthcare All Other HMO |
$2.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$5.73
|
|
|
Service Code
|
NDC 51224-122-30
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.41
|
| Rate for Payer: Blue Distinction Transplant |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4.22
|
| Rate for Payer: Blue Shield of California EPN |
$3.35
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$4.01
|
| Rate for Payer: Cigna of CA PPO |
$4.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.87
|
| Rate for Payer: Dignity Health Media |
$4.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.29
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$4.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2.86
|
| Rate for Payer: United Healthcare HMO Rider |
$2.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4.87
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$5.73
|
|
|
Service Code
|
NDC 51224-122-30
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna of CA HMO |
$4.01
|
| Rate for Payer: Cigna of CA PPO |
$4.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: Galaxy Health WC |
$4.87
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.58
|
| Rate for Payer: Networks By Design Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$4.87
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
NDC 51224-222-30
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.29
|
| Rate for Payer: Blue Distinction Transplant |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.87
|
| Rate for Payer: Cigna of CA PPO |
$3.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.70
|
| Rate for Payer: Dignity Health Media |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2.76
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.70
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-95
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-95
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
IP
|
$5.53
|
|
|
Service Code
|
NDC 51224-222-30
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.83
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO |
$3.87
|
| Rate for Payer: Cigna of CA PPO |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.21
|
| Rate for Payer: Galaxy Health WC |
$4.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.59
|
| Rate for Payer: Prime Health Services Commercial |
$4.70
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-25
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.26
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-25
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.80
|
| Rate for Payer: Blue Distinction Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.72
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$4.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Media |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.55
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.10
|
| Rate for Payer: Networks By Design Commercial |
$4.14
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
OP
|
$39.60
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.59
|
| Rate for Payer: Blue Distinction Transplant |
$23.76
|
| Rate for Payer: Blue Distinction Transplant |
$21.40
|
| Rate for Payer: Blue Distinction Transplant |
$25.98
|
| Rate for Payer: Blue Shield of California Commercial |
$31.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Blue Shield of California Commercial |
$29.19
|
| Rate for Payer: Blue Shield of California EPN |
$23.13
|
| Rate for Payer: Blue Shield of California EPN |
$20.83
|
| Rate for Payer: Blue Shield of California EPN |
$25.29
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cigna of CA HMO |
$24.97
|
| Rate for Payer: Cigna of CA HMO |
$27.72
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$24.97
|
| Rate for Payer: Cigna of CA PPO |
$27.72
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Galaxy Health WC |
$33.66
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.76
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Multiplan Commercial |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$28.54
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Networks By Design Commercial |
$19.80
|
| Rate for Payer: Networks By Design Commercial |
$17.84
|
| Rate for Payer: Prime Health Services Commercial |
$33.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.84
|
| Rate for Payer: United Healthcare All Other HMO |
$17.84
|
| Rate for Payer: United Healthcare All Other HMO |
$19.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.65
|
| Rate for Payer: United Healthcare HMO Rider |
$19.80
|
| Rate for Payer: United Healthcare HMO Rider |
$17.84
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
IP
|
$35.67
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: Blue Shield of California Commercial |
$25.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$30.83
|
| Rate for Payer: Blue Shield of California EPN |
$20.28
|
| Rate for Payer: Blue Shield of California EPN |
$22.17
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA HMO |
$27.72
|
| Rate for Payer: Cigna of CA HMO |
$24.97
|
| Rate for Payer: Cigna of CA PPO |
$24.97
|
| Rate for Payer: Cigna of CA PPO |
$27.72
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.84
|
| Rate for Payer: Galaxy Health WC |
$33.66
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Global Benefits Group Commercial |
$23.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Multiplan Commercial |
$28.54
|
| Rate for Payer: Multiplan Commercial |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$19.80
|
| Rate for Payer: Networks By Design Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.47
|
| Rate for Payer: United Healthcare All Other HMO |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO |
$13.16
|
| Rate for Payer: United Healthcare All Other HMO |
$15.97
|
| Rate for Payer: United Healthcare HMO Rider |
$15.62
|
| Rate for Payer: United Healthcare HMO Rider |
$12.87
|
| Rate for Payer: United Healthcare HMO Rider |
$14.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.29
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
IP
|
$71.34
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1753314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Blue Shield of California Commercial |
$50.79
|
| Rate for Payer: Blue Shield of California Commercial |
$55.54
|
| Rate for Payer: Blue Shield of California Commercial |
$62.63
|
| Rate for Payer: Blue Shield of California EPN |
$39.94
|
| Rate for Payer: Blue Shield of California EPN |
$45.04
|
| Rate for Payer: Blue Shield of California EPN |
$36.53
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$60.64
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Multiplan Commercial |
$57.07
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$35.67
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Prime Health Services Commercial |
$60.64
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.94
|
| Rate for Payer: United Healthcare All Other HMO |
$28.77
|
| Rate for Payer: United Healthcare All Other HMO |
$26.31
|
| Rate for Payer: United Healthcare All Other HMO |
$32.44
|
| Rate for Payer: United Healthcare HMO Rider |
$31.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$28.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.03
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1753314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.47
|
| Rate for Payer: Blue Distinction Transplant |
$46.80
|
| Rate for Payer: Blue Distinction Transplant |
$42.80
|
| Rate for Payer: Blue Distinction Transplant |
$52.78
|
| Rate for Payer: Blue Shield of California Commercial |
$64.83
|
| Rate for Payer: Blue Shield of California Commercial |
$52.58
|
| Rate for Payer: Blue Shield of California Commercial |
$57.49
|
| Rate for Payer: Blue Shield of California EPN |
$45.55
|
| Rate for Payer: Blue Shield of California EPN |
$41.66
|
| Rate for Payer: Blue Shield of California EPN |
$51.37
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna of CA HMO |
$49.94
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$49.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$61.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$60.64
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$74.77
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Global Benefits Group Commercial |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$65.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$4.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$70.38
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$57.07
|
| Rate for Payer: Networks By Design Commercial |
$43.98
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$35.67
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$74.77
|
| Rate for Payer: Prime Health Services Commercial |
$60.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.67
|
| Rate for Payer: United Healthcare All Other HMO |
$35.67
|
| Rate for Payer: United Healthcare All Other HMO |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.98
|
| Rate for Payer: United Healthcare HMO Rider |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.67
|
| Rate for Payer: United Healthcare HMO Rider |
$43.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
IP
|
$148.49
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
NDG100393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Blue Shield of California Commercial |
$105.72
|
| Rate for Payer: Blue Shield of California EPN |
$76.03
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Cigna of CA HMO |
$103.94
|
| Rate for Payer: Cigna of CA PPO |
$103.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.40
|
| Rate for Payer: Galaxy Health WC |
$126.22
|
| Rate for Payer: Global Benefits Group Commercial |
$89.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.64
|
| Rate for Payer: Multiplan Commercial |
$118.79
|
| Rate for Payer: Networks By Design Commercial |
$96.52
|
| Rate for Payer: Prime Health Services Commercial |
$126.22
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
OP
|
$148.49
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
NDG100393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.47
|
| Rate for Payer: Blue Distinction Transplant |
$89.09
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California EPN |
$86.72
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Cigna of CA HMO |
$103.94
|
| Rate for Payer: Cigna of CA PPO |
$103.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.22
|
| Rate for Payer: Dignity Health Media |
$126.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.40
|
| Rate for Payer: Galaxy Health WC |
$126.22
|
| Rate for Payer: Global Benefits Group Commercial |
$89.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.64
|
| Rate for Payer: Multiplan Commercial |
$118.79
|
| Rate for Payer: Networks By Design Commercial |
$96.52
|
| Rate for Payer: Prime Health Services Commercial |
$126.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.24
|
| Rate for Payer: United Healthcare All Other HMO |
$74.24
|
| Rate for Payer: United Healthcare HMO Rider |
$74.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.22
|
| Rate for Payer: Vantage Medical Group Senior |
$126.22
|
|
