|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Central Health Plan Commercial |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.16
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
|
IP
|
$296.17
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$266.55 |
| Rate for Payer: Adventist Health Commercial |
$59.23
|
| Rate for Payer: Blue Shield of California Commercial |
$237.53
|
| Rate for Payer: Blue Shield of California EPN |
$149.27
|
| Rate for Payer: Cash Price |
$133.28
|
| Rate for Payer: Central Health Plan Commercial |
$236.94
|
| Rate for Payer: Cigna of CA HMO |
$207.32
|
| Rate for Payer: Cigna of CA PPO |
$207.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.47
|
| Rate for Payer: EPIC Health Plan Senior |
$118.47
|
| Rate for Payer: Galaxy Health WC |
$251.74
|
| Rate for Payer: Global Benefits Group Commercial |
$177.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$188.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.23
|
| Rate for Payer: Multiplan Commercial |
$222.13
|
| Rate for Payer: Networks By Design Commercial |
$148.09
|
| Rate for Payer: Prime Health Services Commercial |
$251.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.15
|
| Rate for Payer: United Healthcare All Other HMO |
$108.19
|
| Rate for Payer: United Healthcare HMO Rider |
$105.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
|
OP
|
$296.17
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$266.55 |
| Rate for Payer: Adventist Health Commercial |
$59.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$133.28
|
| Rate for Payer: Cash Price |
$133.28
|
| Rate for Payer: Central Health Plan Commercial |
$236.94
|
| Rate for Payer: Cigna of CA HMO |
$207.32
|
| Rate for Payer: Cigna of CA PPO |
$207.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: EPIC Health Plan Senior |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$251.74
|
| Rate for Payer: Global Benefits Group Commercial |
$177.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$188.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.42
|
| Rate for Payer: Multiplan Commercial |
$222.13
|
| Rate for Payer: Networks By Design Commercial |
$148.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$251.74
|
| Rate for Payer: Prime Health Services Medicare |
$2.70
|
| Rate for Payer: Riverside University Health System MISP |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.15
|
| Rate for Payer: United Healthcare All Other HMO |
$108.19
|
| Rate for Payer: United Healthcare HMO Rider |
$105.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Vantage Medical Group Senior |
$2.81
|
|
|
CEFIDEROCOL (FETROJA) 1 GM/100 ML IVPB [40820782]
|
Facility
|
IP
|
$296.17
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$266.55 |
| Rate for Payer: Adventist Health Commercial |
$59.23
|
| Rate for Payer: Blue Shield of California Commercial |
$237.53
|
| Rate for Payer: Blue Shield of California EPN |
$149.27
|
| Rate for Payer: Cash Price |
$133.28
|
| Rate for Payer: Central Health Plan Commercial |
$236.94
|
| Rate for Payer: Cigna of CA HMO |
$207.32
|
| Rate for Payer: Cigna of CA PPO |
$207.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.47
|
| Rate for Payer: EPIC Health Plan Senior |
$118.47
|
| Rate for Payer: Galaxy Health WC |
$251.74
|
| Rate for Payer: Global Benefits Group Commercial |
$177.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$188.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.23
|
| Rate for Payer: Multiplan Commercial |
$222.13
|
| Rate for Payer: Networks By Design Commercial |
$148.09
|
| Rate for Payer: Prime Health Services Commercial |
$251.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.15
|
| Rate for Payer: United Healthcare All Other HMO |
$108.19
|
| Rate for Payer: United Healthcare HMO Rider |
$105.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
|
|
CEFIDEROCOL (FETROJA) 1 GM/100 ML IVPB [40820782]
|
Facility
|
OP
|
$296.17
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$266.55 |
| Rate for Payer: Adventist Health Commercial |
$59.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.64
|
| Rate for Payer: Cash Price |
$133.28
|
| Rate for Payer: Cash Price |
$133.28
|
| Rate for Payer: Central Health Plan Commercial |
$236.94
|
| Rate for Payer: Cigna of CA HMO |
$207.32
|
| Rate for Payer: Cigna of CA PPO |
$207.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.21
|
| Rate for Payer: EPIC Health Plan Senior |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$251.74
|
| Rate for Payer: Global Benefits Group Commercial |
$177.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$188.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.42
|
| Rate for Payer: Multiplan Commercial |
$222.13
|
| Rate for Payer: Networks By Design Commercial |
$148.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.55
|
| Rate for Payer: Prime Health Services Commercial |
$251.74
|
| Rate for Payer: Prime Health Services Medicare |
$2.70
|
| Rate for Payer: Riverside University Health System MISP |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.15
|
| Rate for Payer: United Healthcare All Other HMO |
$108.19
|
| Rate for Payer: United Healthcare HMO Rider |
$105.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.81
|
| Rate for Payer: Vantage Medical Group Senior |
$2.81
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 6586275275
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California EPN |
$4.04
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Senior |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 6586275275
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$5.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Senior |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Riverside University Health System MISP |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
|
OP
|
$107.99
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: Networks By Design Commercial |
$53.99
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
| Rate for Payer: Riverside University Health System MISP |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.53
|
| Rate for Payer: United Healthcare All Other HMO |
$39.45
|
| Rate for Payer: United Healthcare HMO Rider |
$38.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.79
|
| Rate for Payer: Vantage Medical Group Senior |
$91.79
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
|
IP
|
$107.99
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$86.61
|
| Rate for Payer: Blue Shield of California EPN |
$54.43
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: Networks By Design Commercial |
$53.99
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.53
|
| Rate for Payer: United Healthcare All Other HMO |
$39.45
|
| Rate for Payer: United Healthcare HMO Rider |
$38.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.37
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$39.86 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Riverside University Health System MISP |
$3.36
|
| Rate for Payer: Riverside University Health System MISP |
$4.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$10.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
IP
|
$8.39
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Blue Shield of California Commercial |
$6.73
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9.53
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Blue Shield of California EPN |
$4.23
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.71
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Senior |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$4.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.89
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$39.86 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California Commercial |
$9.23
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$8.39
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.40
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Riverside University Health System MISP |
$6.70
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Riverside University Health System MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$14.24
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7.70
|
| Rate for Payer: Blue Shield of California Commercial |
$13.43
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Blue Shield of California EPN |
$4.84
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Central Health Plan Commercial |
$13.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 6586209620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.79
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
| Rate for Payer: Riverside University Health System MISP |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.81
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 6586209620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.59
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
IP
|
$324.40
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$291.96 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Blue Shield of California Commercial |
$260.17
|
| Rate for Payer: Blue Shield of California EPN |
$163.50
|
| Rate for Payer: Cash Price |
$145.98
|
| Rate for Payer: Central Health Plan Commercial |
$259.52
|
| Rate for Payer: Cigna of CA HMO |
$227.08
|
| Rate for Payer: Cigna of CA PPO |
$227.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.76
|
| Rate for Payer: EPIC Health Plan Senior |
$129.76
|
| Rate for Payer: Galaxy Health WC |
$275.74
|
| Rate for Payer: Global Benefits Group Commercial |
$194.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.88
|
| Rate for Payer: Multiplan Commercial |
$243.30
|
| Rate for Payer: Networks By Design Commercial |
$162.20
|
| Rate for Payer: Prime Health Services Commercial |
$275.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.75
|
| Rate for Payer: United Healthcare All Other HMO |
$118.50
|
| Rate for Payer: United Healthcare HMO Rider |
$115.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.24
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
OP
|
$324.40
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$291.96 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Cash Price |
$145.98
|
| Rate for Payer: Cash Price |
$145.98
|
| Rate for Payer: Central Health Plan Commercial |
$259.52
|
| Rate for Payer: Cigna of CA HMO |
$227.08
|
| Rate for Payer: Cigna of CA PPO |
$227.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$275.74
|
| Rate for Payer: Global Benefits Group Commercial |
$194.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$243.30
|
| Rate for Payer: Networks By Design Commercial |
$162.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$275.74
|
| Rate for Payer: Prime Health Services Medicare |
$4.65
|
| Rate for Payer: Riverside University Health System MISP |
$4.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.75
|
| Rate for Payer: United Healthcare All Other HMO |
$118.50
|
| Rate for Payer: United Healthcare HMO Rider |
$115.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4.83
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
IP
|
$324.40
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$291.96 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Adventist Health Commercial |
$56.06
|
| Rate for Payer: Blue Shield of California Commercial |
$260.17
|
| Rate for Payer: Blue Shield of California Commercial |
$224.78
|
| Rate for Payer: Blue Shield of California EPN |
$141.26
|
| Rate for Payer: Blue Shield of California EPN |
$163.50
|
| Rate for Payer: Cash Price |
$145.98
|
| Rate for Payer: Cash Price |
$126.13
|
| Rate for Payer: Central Health Plan Commercial |
$259.52
|
| Rate for Payer: Central Health Plan Commercial |
$224.22
|
| Rate for Payer: Cigna of CA HMO |
$196.20
|
| Rate for Payer: Cigna of CA HMO |
$227.08
|
| Rate for Payer: Cigna of CA PPO |
$196.20
|
| Rate for Payer: Cigna of CA PPO |
$227.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.76
|
| Rate for Payer: EPIC Health Plan Senior |
$112.11
|
| Rate for Payer: EPIC Health Plan Senior |
$129.76
|
| Rate for Payer: Galaxy Health WC |
$275.74
|
| Rate for Payer: Galaxy Health WC |
$238.24
|
| Rate for Payer: Global Benefits Group Commercial |
$168.17
|
| Rate for Payer: Global Benefits Group Commercial |
$194.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.06
|
| Rate for Payer: Multiplan Commercial |
$210.21
|
| Rate for Payer: Multiplan Commercial |
$243.30
|
| Rate for Payer: Networks By Design Commercial |
$140.14
|
| Rate for Payer: Networks By Design Commercial |
$162.20
|
| Rate for Payer: Prime Health Services Commercial |
$275.74
|
| Rate for Payer: Prime Health Services Commercial |
$238.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.75
|
| Rate for Payer: United Healthcare All Other HMO |
$118.50
|
| Rate for Payer: United Healthcare All Other HMO |
$102.39
|
| Rate for Payer: United Healthcare HMO Rider |
$100.17
|
| Rate for Payer: United Healthcare HMO Rider |
$115.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.24
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
OP
|
$324.40
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$291.96 |
| Rate for Payer: Adventist Health Commercial |
$64.88
|
| Rate for Payer: Adventist Health Commercial |
$56.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Blue Shield of California EPN |
$6.13
|
| Rate for Payer: Cash Price |
$145.98
|
| Rate for Payer: Cash Price |
$126.13
|
| Rate for Payer: Cash Price |
$126.13
|
| Rate for Payer: Cash Price |
$145.98
|
| Rate for Payer: Central Health Plan Commercial |
$259.52
|
| Rate for Payer: Central Health Plan Commercial |
$224.22
|
| Rate for Payer: Cigna of CA HMO |
$227.08
|
| Rate for Payer: Cigna of CA HMO |
$196.20
|
| Rate for Payer: Cigna of CA PPO |
$227.08
|
| Rate for Payer: Cigna of CA PPO |
$196.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.83
|
| Rate for Payer: EPIC Health Plan Senior |
$4.83
|
| Rate for Payer: Galaxy Health WC |
$238.24
|
| Rate for Payer: Galaxy Health WC |
$275.74
|
| Rate for Payer: Global Benefits Group Commercial |
$194.64
|
| Rate for Payer: Global Benefits Group Commercial |
$168.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$291.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$210.21
|
| Rate for Payer: Multiplan Commercial |
$243.30
|
| Rate for Payer: Networks By Design Commercial |
$140.14
|
| Rate for Payer: Networks By Design Commercial |
$162.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$238.24
|
| Rate for Payer: Prime Health Services Commercial |
$275.74
|
| Rate for Payer: Prime Health Services Medicare |
$4.65
|
| Rate for Payer: Prime Health Services Medicare |
$4.65
|
| Rate for Payer: Riverside University Health System MISP |
$4.83
|
| Rate for Payer: Riverside University Health System MISP |
$4.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$194.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$194.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.75
|
| Rate for Payer: United Healthcare All Other HMO |
$102.39
|
| Rate for Payer: United Healthcare All Other HMO |
$118.50
|
| Rate for Payer: United Healthcare HMO Rider |
$115.94
|
| Rate for Payer: United Healthcare HMO Rider |
$100.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4.83
|
|
|
CEFTAZIDIME 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080886]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
|
|
CEFTAZIDIME 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080886]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: Riverside University Health System MISP |
$2.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$6.07
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
|
IP
|
$7.14
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$4.99
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$4.37
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$1.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$3.32
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.99
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$4.37
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$3.32
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Riverside University Health System MISP |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Riverside University Health System MISP |
$1.56
|
| Rate for Payer: Riverside University Health System MISP |
$2.50
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.61
|
| Rate for Payer: United Healthcare HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$2.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
|
