|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| 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 |
$4.59
|
| 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 Commercial/Exchange |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| 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 Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| 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: 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: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| 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 |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| 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 |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$4.37
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$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 |
$3.78
|
| 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 |
$4.35
|
| 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 |
$5.30
|
| 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 |
$4.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| 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 Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$1.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| 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: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| 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 |
$3.43
|
| 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 Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| 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 |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Riverside University Health System MISP |
$2.05
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.74
|
| 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 |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.34
|
| 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 HMO Rider |
$1.93
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| 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 |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
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: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| 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 |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$4.37
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.78
|
| 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 Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.05
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.50
|
| Rate for Payer: EPIC Health Plan Senior |
$1.56
|
| 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: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.62
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.96
|
| 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 |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.68
|
| 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 |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| 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: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| 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: United Healthcare All Other Commercial |
$2.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.03
|
| 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 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 |
$1.97
|
| 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 |
$2.23
|
| Rate for Payer: United Healthcare HMO Rider |
$1.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.77
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| 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 |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: Riverside University Health System MISP |
$5.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.45
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.64
|
| Rate for Payer: Blue Shield of California EPN |
$7.31
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$10.16
|
| Rate for Payer: Cigna of CA PPO |
$10.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.45
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.29
|
| 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 |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| 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: 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: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.02
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.58
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| 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 |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.73
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.74
|
| Rate for Payer: Riverside University Health System MISP |
$4.80
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Riverside University Health System MISP |
$4.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$9.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California Commercial |
$9.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.78
|
| Rate for Payer: Blue Shield of California EPN |
$6.65
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA HMO |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.58
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$8.60
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$5.73
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$9.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.75
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
|
OP
|
$36.68
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$33.01 |
| Rate for Payer: Adventist Health Commercial |
$7.34
|
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| 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 |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| 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: 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: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Central Health Plan Commercial |
$20.82
|
| Rate for Payer: Central Health Plan Commercial |
$23.04
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Central Health Plan Commercial |
$29.34
|
| Rate for Payer: Cigna of CA HMO |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$25.68
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$25.68
|
| Rate for Payer: Cigna of CA PPO |
$20.16
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.67
|
| Rate for Payer: EPIC Health Plan Senior |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$11.52
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$24.48
|
| Rate for Payer: Galaxy Health WC |
$31.18
|
| Rate for Payer: Global Benefits Group Commercial |
$22.01
|
| Rate for Payer: Global Benefits Group Commercial |
$17.28
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| 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 |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Networks By Design Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$18.34
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$24.48
|
| Rate for Payer: Prime Health Services Commercial |
$31.18
|
| Rate for Payer: Riverside University Health System MISP |
$11.52
|
| Rate for Payer: Riverside University Health System MISP |
$14.00
|
| Rate for Payer: Riverside University Health System MISP |
$10.41
|
| Rate for Payer: Riverside University Health System MISP |
$14.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO |
$10.52
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$13.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.18
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$24.48
|
| Rate for Payer: Vantage Medical Group Senior |
$31.18
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
|
IP
|
$28.80
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Adventist Health Commercial |
$7.34
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$23.10
|
| Rate for Payer: Blue Shield of California Commercial |
$20.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.42
|
| Rate for Payer: Blue Shield of California Commercial |
$28.07
|
| Rate for Payer: Blue Shield of California EPN |
$14.52
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$17.64
|
| Rate for Payer: Blue Shield of California EPN |
$18.49
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Central Health Plan Commercial |
$29.34
|
| Rate for Payer: Central Health Plan Commercial |
$23.04
|
| Rate for Payer: Central Health Plan Commercial |
$20.82
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$24.50
|
| Rate for Payer: Cigna of CA HMO |
$25.68
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$18.22
|
| Rate for Payer: Cigna of CA PPO |
$20.16
|
| Rate for Payer: Cigna of CA PPO |
$24.50
|
| Rate for Payer: Cigna of CA PPO |
$25.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Senior |
$11.52
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.67
|
| Rate for Payer: EPIC Health Plan Senior |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$24.48
|
| Rate for Payer: Galaxy Health WC |
$31.18
|
| Rate for Payer: Global Benefits Group Commercial |
$22.01
|
| Rate for Payer: Global Benefits Group Commercial |
$17.28
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$18.34
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Networks By Design Commercial |
$17.50
|
| Rate for Payer: Networks By Design Commercial |
$14.40
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Commercial |
$24.48
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Prime Health Services Commercial |
$31.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.81
|
| Rate for Payer: United Healthcare All Other HMO |
$10.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$13.40
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare HMO Rider |
$12.51
|
| Rate for Payer: United Healthcare HMO Rider |
$13.11
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
|
IP
|
$523.36
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.67 |
| Max. Negotiated Rate |
$471.02 |
| Rate for Payer: Adventist Health Commercial |
$104.67
|
| Rate for Payer: Blue Shield of California Commercial |
$419.73
|
| Rate for Payer: Blue Shield of California EPN |
$263.77
|
| Rate for Payer: Cash Price |
$235.51
|
| Rate for Payer: Central Health Plan Commercial |
$418.69
|
| Rate for Payer: Cigna of CA HMO |
$366.35
|
| Rate for Payer: Cigna of CA PPO |
$366.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.34
|
| Rate for Payer: EPIC Health Plan Senior |
$209.34
|
| Rate for Payer: Galaxy Health WC |
$444.86
|
| Rate for Payer: Global Benefits Group Commercial |
$314.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.67
|
| Rate for Payer: Multiplan Commercial |
$392.52
|
| Rate for Payer: Networks By Design Commercial |
$261.68
|
| Rate for Payer: Prime Health Services Commercial |
$444.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.42
|
| Rate for Payer: United Healthcare All Other HMO |
$191.18
|
| Rate for Payer: United Healthcare HMO Rider |
$187.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.40
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
|
OP
|
$523.36
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.67 |
| Max. Negotiated Rate |
$622.77 |
| Rate for Payer: Adventist Health Commercial |
$104.67
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$622.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.92
|
| Rate for Payer: Blue Shield of California Commercial |
$130.55
|
| Rate for Payer: Blue Shield of California EPN |
$118.68
|
| Rate for Payer: Cash Price |
$235.51
|
| Rate for Payer: Cash Price |
$235.51
|
| Rate for Payer: Central Health Plan Commercial |
$418.69
|
| Rate for Payer: Cigna of CA HMO |
$366.35
|
| Rate for Payer: Cigna of CA PPO |
$366.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.12
|
| Rate for Payer: EPIC Health Plan Senior |
$120.75
|
| Rate for Payer: Galaxy Health WC |
$444.86
|
| Rate for Payer: Global Benefits Group Commercial |
$314.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$180.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.09
|
| Rate for Payer: Multiplan Commercial |
$392.52
|
| Rate for Payer: Networks By Design Commercial |
$261.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.77
|
| Rate for Payer: Prime Health Services Commercial |
$444.86
|
| Rate for Payer: Prime Health Services Medicare |
$116.36
|
| Rate for Payer: Riverside University Health System MISP |
$120.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$314.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$314.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.42
|
| Rate for Payer: United Healthcare All Other HMO |
$191.18
|
| Rate for Payer: United Healthcare HMO Rider |
$187.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.75
|
| Rate for Payer: Vantage Medical Group Senior |
$120.75
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.33 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
|
OP
|
$229.96
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$206.96 |
| Rate for Payer: Adventist Health Commercial |
$45.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.24
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Central Health Plan Commercial |
$183.97
|
| Rate for Payer: Cigna of CA HMO |
$160.97
|
| Rate for Payer: Cigna of CA PPO |
$160.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: Galaxy Health WC |
$195.47
|
| Rate for Payer: Global Benefits Group Commercial |
$137.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.45
|
| Rate for Payer: Multiplan Commercial |
$172.47
|
| Rate for Payer: Networks By Design Commercial |
$114.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.04
|
| Rate for Payer: Prime Health Services Commercial |
$195.47
|
| Rate for Payer: Prime Health Services Medicare |
$10.64
|
| Rate for Payer: Riverside University Health System MISP |
$11.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.30
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$82.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.04
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
|
IP
|
$229.96
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$206.96 |
| Rate for Payer: Adventist Health Commercial |
$45.99
|
| Rate for Payer: Blue Shield of California Commercial |
$184.43
|
| Rate for Payer: Blue Shield of California EPN |
$115.90
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Central Health Plan Commercial |
$183.97
|
| Rate for Payer: Cigna of CA HMO |
$160.97
|
| Rate for Payer: Cigna of CA PPO |
$160.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.98
|
| Rate for Payer: EPIC Health Plan Senior |
$91.98
|
| Rate for Payer: Galaxy Health WC |
$195.47
|
| Rate for Payer: Global Benefits Group Commercial |
$137.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$206.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.99
|
| Rate for Payer: Multiplan Commercial |
$172.47
|
| Rate for Payer: Networks By Design Commercial |
$114.98
|
| Rate for Payer: Prime Health Services Commercial |
$195.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.30
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$82.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.31
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.03
|
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California Commercial |
$16.67
|
| Rate for Payer: Blue Shield of California Commercial |
$32.20
|
| Rate for Payer: Blue Shield of California Commercial |
$25.60
|
| Rate for Payer: Blue Shield of California EPN |
$12.10
|
| Rate for Payer: Blue Shield of California EPN |
$10.47
|
| Rate for Payer: Blue Shield of California EPN |
$16.09
|
| Rate for Payer: Blue Shield of California EPN |
$20.24
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$32.12
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: Central Health Plan Commercial |
$25.54
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$22.34
|
| Rate for Payer: Cigna of CA HMO |
$28.11
|
| Rate for Payer: Cigna of CA HMO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$22.34
|
| Rate for Payer: Cigna of CA PPO |
$28.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.31
|
| Rate for Payer: Galaxy Health WC |
$27.13
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$34.13
|
| Rate for Payer: Global Benefits Group Commercial |
$24.09
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.15
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$30.11
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$23.94
|
| Rate for Payer: Networks By Design Commercial |
$20.07
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Networks By Design Commercial |
$15.96
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.13
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Prime Health Services Commercial |
$34.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare All Other HMO |
$7.59
|
| Rate for Payer: United Healthcare All Other HMO |
$14.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare HMO Rider |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
|
OP
|
$40.15
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$36.13 |
| Rate for Payer: Adventist Health Commercial |
$8.03
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: Central Health Plan Commercial |
$32.12
|
| Rate for Payer: Central Health Plan Commercial |
$25.54
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$22.34
|
| Rate for Payer: Cigna of CA HMO |
$28.11
|
| Rate for Payer: Cigna of CA HMO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$22.34
|
| Rate for Payer: Cigna of CA PPO |
$28.11
|
| Rate for Payer: Cigna of CA PPO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$12.77
|
| Rate for Payer: EPIC Health Plan Senior |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$34.13
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$27.13
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Global Benefits Group Commercial |
$24.09
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.15
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.11
|
| Rate for Payer: Multiplan Commercial |
$23.94
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$30.11
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$20.07
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$15.96
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Prime Health Services Commercial |
$34.13
|
| Rate for Payer: Prime Health Services Commercial |
$27.13
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$8.31
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Riverside University Health System MISP |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$16.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.07
|
| Rate for Payer: United Healthcare All Other HMO |
$14.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7.59
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$11.41
|
| Rate for Payer: United Healthcare HMO Rider |
$7.43
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$34.13
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$27.13
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
IP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Central Health Plan Commercial |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$33.94 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Central Health Plan Commercial |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: Riverside University Health System MISP |
$0.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1.56
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.47
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$1.46
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$33.94 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Central Health Plan Commercial |
$1.46
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$1.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$1.56
|
| Rate for Payer: Global Benefits Group Commercial |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$0.92
|
| Rate for Payer: Prime Health Services Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Riverside University Health System MISP |
$0.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.56
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$33.94 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
| Rate for Payer: Riverside University Health System MISP |
$0.64
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.81
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$0.73
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$1.13
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$1.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.81
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$33.94 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Central Health Plan Commercial |
$0.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.34
|
| Rate for Payer: Central Health Plan Commercial |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA HMO |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$1.18
|
| Rate for Payer: Cigna of CA PPO |
$1.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.81
|
| Rate for Payer: EPIC Health Plan Senior |
$0.67
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Networks By Design Commercial |
$0.84
|
| Rate for Payer: Networks By Design Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.73
|
| Rate for Payer: Prime Health Services Commercial |
$1.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.67
|
| Rate for Payer: Riverside University Health System MISP |
$0.81
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
|
