|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
IP
|
$1.45
|
|
|
Service Code
|
NDC 68001-362-06
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
|
|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 57237-099-60
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.59
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
ERX223402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$297.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$405.00
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
ERX223402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Blue Shield of California Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California EPN |
$288.36
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$270.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]
|
Facility
IP
|
$7.62
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1750496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Blue Shield of California Commercial |
$5.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Blue Shield of California EPN |
$4.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.85
|
| Rate for Payer: Central Health Plan Commercial |
$4.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$5.33
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$5.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$5.14
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Networks By Design Commercial |
$3.03
|
| Rate for Payer: Networks By Design Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$3.02
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$5.15
|
| Rate for Payer: Prime Health Services Commercial |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$5.14
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]
|
Facility
OP
|
$7.62
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1750496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: BCBS Transplant Transplant |
$4.57
|
| Rate for Payer: BCBS Transplant Transplant |
$3.64
|
| Rate for Payer: BCBS Transplant Transplant |
$3.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Central Health Plan Commercial |
$4.84
|
| Rate for Payer: Central Health Plan Commercial |
$4.85
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.33
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.33
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Cigna of CA PPO |
$4.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$5.14
|
| Rate for Payer: Galaxy Health WC |
$5.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Global Benefits Group Commercial |
$3.63
|
| Rate for Payer: Global Benefits Group Commercial |
$4.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$3.03
|
| Rate for Payer: Networks By Design Commercial |
$3.81
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$5.15
|
| Rate for Payer: Prime Health Services Commercial |
$5.14
|
| Rate for Payer: Riverside University Health MISP |
$3.05
|
| Rate for Payer: Riverside University Health MISP |
$2.88
|
| Rate for Payer: Riverside University Health MISP |
$2.42
|
| Rate for Payer: Riverside University Health MISP |
$2.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.81
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$3.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.14
|
| Rate for Payer: Vantage Medical Group Senior |
$5.15
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]
|
Facility
IP
|
$11.76
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1720938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Blue Shield of California Commercial |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.76
|
| Rate for Payer: Blue Shield of California EPN |
$6.95
|
| Rate for Payer: Blue Shield of California EPN |
$6.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.44
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.41
|
| Rate for Payer: Central Health Plan Commercial |
$9.65
|
| Rate for Payer: Central Health Plan Commercial |
$9.41
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$8.23
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$8.44
|
| Rate for Payer: Cigna of CA PPO |
$8.23
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$10.25
|
| Rate for Payer: Galaxy Health WC |
$11.06
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$11.06
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]
|
Facility
OP
|
$13.01
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1720938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$7.06
|
| Rate for Payer: BCBS Transplant Transplant |
$7.81
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: BCBS Transplant Transplant |
$7.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Central Health Plan Commercial |
$9.65
|
| Rate for Payer: Central Health Plan Commercial |
$10.41
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.41
|
| Rate for Payer: Cigna of CA HMO |
$8.44
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$8.23
|
| Rate for Payer: Cigna of CA HMO |
$9.11
|
| Rate for Payer: Cigna of CA PPO |
$8.23
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.44
|
| Rate for Payer: Cigna of CA PPO |
$9.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$10.25
|
| Rate for Payer: Galaxy Health WC |
$11.06
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Global Benefits Group Commercial |
$7.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.04
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.25
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.06
|
| Rate for Payer: Riverside University Health MISP |
$4.70
|
| Rate for Payer: Riverside University Health MISP |
$5.20
|
| Rate for Payer: Riverside University Health MISP |
$4.82
|
| Rate for Payer: Riverside University Health MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.03
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| 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 |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| 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 |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| 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 |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| 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 |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| 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 |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| 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 |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| 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 |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| 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 |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
IP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Blue Shield of California Commercial |
$188.28
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Central Health Plan Commercial |
$200.83
|
| Rate for Payer: Cigna of CA HMO |
$175.73
|
| Rate for Payer: Cigna of CA PPO |
$175.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.42
|
| Rate for Payer: Galaxy Health WC |
$213.38
|
| Rate for Payer: Global Benefits Group Commercial |
$150.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.21
|
| Rate for Payer: Multiplan Commercial |
$188.28
|
| Rate for Payer: Networks By Design Commercial |
$125.52
|
| Rate for Payer: Prime Health Services Commercial |
$213.38
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
OP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.07
|
| Rate for Payer: BCBS Transplant Transplant |
$150.62
|
| Rate for Payer: Blue Shield of California Commercial |
$157.90
|
| Rate for Payer: Blue Shield of California EPN |
$122.76
|
| Rate for Payer: Caremore Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Central Health Plan Commercial |
$200.83
|
| Rate for Payer: Cigna of CA HMO |
$175.73
|
| Rate for Payer: Cigna of CA PPO |
$175.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$213.38
|
| Rate for Payer: Global Benefits Group Commercial |
$150.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$188.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.56
|
| Rate for Payer: IEHP medi-cal |
$3.59
|
| Rate for Payer: IEHP Medicare Advantage |
$2.17
|
| Rate for Payer: Innovage PACE Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$188.28
|
| Rate for Payer: Networks By Design Commercial |
$125.52
|
| Rate for Payer: Prime Health Services Commercial |
$213.38
|
| Rate for Payer: Prime Health Services Medicare |
$2.30
|
| Rate for Payer: Riverside University Health MISP |
$2.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.52
|
| Rate for Payer: United Healthcare All Other HMO |
$125.52
|
| Rate for Payer: United Healthcare HMO Rider |
$125.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.39
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
OP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: BCBS Transplant Transplant |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Blue Shield of California EPN |
$5.33
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Central Health Plan Commercial |
$8.71
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.26
|
| Rate for Payer: Global Benefits Group Commercial |
$6.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.17
|
| Rate for Payer: IEHP medi-cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$8.17
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$9.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.53
|
| Rate for Payer: Riverside University Health MISP |
$4.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO |
$5.44
|
| Rate for Payer: United Healthcare HMO Rider |
$5.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Vantage Medical Group Senior |
$9.26
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
OP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.74
|
| Rate for Payer: BCBS Transplant Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.02
|
| Rate for Payer: IEHP medi-cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: Riverside University Health MISP |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
IP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Blue Shield of California Commercial |
$8.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Central Health Plan Commercial |
$8.71
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$7.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.26
|
| Rate for Payer: Global Benefits Group Commercial |
$6.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$8.17
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$9.26
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
IP
|
$107.99
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Blue Shield of California Commercial |
$80.99
|
| Rate for Payer: Blue Shield of California EPN |
$57.67
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
OP
|
$107.99
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: BCBS Transplant Transplant |
$64.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$80.99
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
| Rate for Payer: Riverside University Health MISP |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.79
|
| Rate for Payer: Vantage Medical Group Senior |
$91.79
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
OP
|
$11.88
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Riverside University Health MISP |
$2.88
|
| Rate for Payer: Riverside University Health MISP |
$4.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$10.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
