|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
IP
|
$11.88
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Blue Shield of California Commercial |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Central Health Plan Commercial |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
IP
|
$16.75
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$15.08 |
| Rate for Payer: Blue Shield of California Commercial |
$12.56
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$12.78
|
| Rate for Payer: Blue Shield of California EPN |
$8.94
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$13.40
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$11.97
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Networks By Design Commercial |
$3.84
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
OP
|
$23.94
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| 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: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| 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 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: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: BCBS Transplant Transplant |
$4.61
|
| Rate for Payer: BCBS Transplant Transplant |
$10.05
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: BCBS Transplant Transplant |
$14.36
|
| 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 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: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$13.40
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Cigna of CA HMO |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| Rate for Payer: Cigna of CA PPO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.96
|
| 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: IEHP medi-cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$8.38
|
| Rate for Payer: Networks By Design Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$11.97
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$6.54
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$14.24
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Riverside University Health MISP |
$3.08
|
| Rate for Payer: Riverside University Health MISP |
$4.80
|
| Rate for Payer: Riverside University Health MISP |
$6.70
|
| Rate for Payer: Riverside University Health MISP |
$9.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$8.38
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$8.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$6.54
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
IP
|
$4.48
|
|
|
Service Code
|
NDC 65862-096-20
|
| Hospital Charge Code |
ERX9469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Blue Shield of California Commercial |
$3.36
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
OP
|
$4.48
|
|
|
Service Code
|
NDC 65862-096-20
|
| Hospital Charge Code |
ERX9469
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: BCBS Transplant Transplant |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.82
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Central Health Plan Commercial |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$3.14
|
| Rate for Payer: Cigna of CA PPO |
$3.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.79
|
| Rate for Payer: Galaxy Health WC |
$3.81
|
| Rate for Payer: Global Benefits Group Commercial |
$2.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.36
|
| Rate for Payer: IEHP medi-cal |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: Networks By Design Commercial |
$2.91
|
| Rate for Payer: Prime Health Services Commercial |
$3.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: Riverside University Health MISP |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.24
|
| Rate for Payer: United Healthcare All Other HMO |
$2.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.81
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
IP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Blue Shield of California Commercial |
$210.16
|
| Rate for Payer: Blue Shield of California Commercial |
$210.17
|
| Rate for Payer: Blue Shield of California EPN |
$149.64
|
| Rate for Payer: Blue Shield of California EPN |
$149.64
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.04
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
OP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: BCBS Transplant Transplant |
$168.13
|
| Rate for Payer: BCBS Transplant Transplant |
$168.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Caremore Medicare Advantage |
$3.84
|
| Rate for Payer: Caremore Medicare Advantage |
$3.84
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.29
|
| Rate for Payer: IEHP medi-cal |
$6.33
|
| Rate for Payer: IEHP medi-cal |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$3.84
|
| Rate for Payer: IEHP Medicare Advantage |
$3.84
|
| Rate for Payer: Innovage PACE Commercial |
$5.75
|
| Rate for Payer: Innovage PACE Commercial |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
| Rate for Payer: Prime Health Services Medicare |
$4.07
|
| Rate for Payer: Prime Health Services Medicare |
$4.07
|
| Rate for Payer: Riverside University Health MISP |
$4.22
|
| Rate for Payer: Riverside University Health MISP |
$4.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.12
|
| Rate for Payer: United Healthcare All Other HMO |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.12
|
| Rate for Payer: United Healthcare HMO Rider |
$140.11
|
| Rate for Payer: United Healthcare HMO Rider |
$140.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
OP
|
$280.23
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$252.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: BCBS Transplant Transplant |
$168.14
|
| Rate for Payer: BCBS Transplant Transplant |
$168.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.54
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Caremore Medicare Advantage |
$3.84
|
| Rate for Payer: Caremore Medicare Advantage |
$3.84
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.29
|
| Rate for Payer: IEHP medi-cal |
$6.33
|
| Rate for Payer: IEHP medi-cal |
$6.33
|
| Rate for Payer: IEHP Medicare Advantage |
$3.84
|
| Rate for Payer: IEHP Medicare Advantage |
$3.84
|
| Rate for Payer: Innovage PACE Commercial |
$5.75
|
| Rate for Payer: Innovage PACE Commercial |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: Prime Health Services Medicare |
$4.07
|
| Rate for Payer: Prime Health Services Medicare |
$4.07
|
| Rate for Payer: Riverside University Health MISP |
$4.22
|
| Rate for Payer: Riverside University Health MISP |
$4.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.12
|
| Rate for Payer: United Healthcare All Other HMO |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.12
|
| Rate for Payer: United Healthcare HMO Rider |
$140.12
|
| Rate for Payer: United Healthcare HMO Rider |
$140.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
IP
|
$280.23
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.05 |
| Max. Negotiated Rate |
$252.21 |
| Rate for Payer: Blue Shield of California Commercial |
$210.17
|
| Rate for Payer: Blue Shield of California Commercial |
$210.16
|
| Rate for Payer: Blue Shield of California EPN |
$149.64
|
| Rate for Payer: Blue Shield of California EPN |
$149.64
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Central Health Plan Commercial |
$224.18
|
| Rate for Payer: Cigna of CA HMO |
$196.16
|
| Rate for Payer: Cigna of CA HMO |
$196.15
|
| Rate for Payer: Cigna of CA PPO |
$196.16
|
| Rate for Payer: Cigna of CA PPO |
$196.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.09
|
| Rate for Payer: Galaxy Health WC |
$238.20
|
| Rate for Payer: Galaxy Health WC |
$238.19
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.05
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Networks By Design Commercial |
$140.11
|
| Rate for Payer: Networks By Design Commercial |
$140.12
|
| Rate for Payer: Prime Health Services Commercial |
$238.20
|
| Rate for Payer: Prime Health Services Commercial |
$238.19
|
|
|
CEFTAZIDIME 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080886]
|
Facility
IP
|
$5.12
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4080886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
|
|
CEFTAZIDIME 10 MG/ML SERIAL DILUTION FOR MIXTURES [4080886]
|
Facility
OP
|
$5.12
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4080886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.84
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
IP
|
$7.14
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX27290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: Blue Shield of California Commercial |
$5.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
OP
|
$7.14
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX27290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.36
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: Riverside University Health MISP |
$2.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO |
$3.57
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$6.07
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
IP
|
$3.91
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4081895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$4.99
|
| Rate for Payer: Central Health Plan Commercial |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| 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 |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| 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 Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| 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 |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| 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 |
$5.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
OP
|
$6.24
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4081895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: BCBS Transplant Transplant |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$3.74
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: BCBS Transplant Transplant |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.71
|
| Rate for Payer: Central Health Plan Commercial |
$4.99
|
| 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 |
$3.13
|
| 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 HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| 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: Cigna of CA PPO |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$3.32
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| 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 |
$3.74
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.43
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.36
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: 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 |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Networks By Design Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
| 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 |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$6.07
|
| Rate for Payer: Riverside University Health MISP |
$2.86
|
| Rate for Payer: Riverside University Health MISP |
$2.50
|
| Rate for Payer: Riverside University Health MISP |
$1.56
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Riverside University Health MISP |
$2.16
|
| 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 |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
IP
|
$5.40
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3.84
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.33
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$3.13
|
| Rate for Payer: Central Health Plan Commercial |
$4.99
|
| Rate for Payer: Central Health Plan Commercial |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$4.37
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| 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: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$3.32
|
| Rate for Payer: Galaxy Health WC |
$4.35
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| 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: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| 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: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| 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 |
$4.59
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
OP
|
$5.40
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| 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 |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$2.35
|
| Rate for Payer: BCBS Transplant Transplant |
$3.74
|
| Rate for Payer: BCBS Transplant Transplant |
$3.07
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| 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 |
$4.99
|
| 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 |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$2.74
|
| 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 |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$2.74
|
| 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 Commercial/Exchange |
$5.30
|
| 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 |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.50
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| 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: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Global Benefits Group Commercial |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.93
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| 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: LLUH Dept of Risk Management WC |
$1.02
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$3.12
|
| Rate for Payer: Networks By Design Commercial |
$1.96
|
| Rate for Payer: Prime Health Services Commercial |
$4.35
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Prime Health Services Commercial |
$3.32
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Riverside University Health MISP |
$2.16
|
| Rate for Payer: Riverside University Health MISP |
$2.50
|
| Rate for Payer: Riverside University Health MISP |
$1.56
|
| Rate for Payer: Riverside University Health MISP |
$2.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.07
|
| Rate for Payer: 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: TriValley Medical Group Commercial/Senior |
$3.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.96
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.12
|
| 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 Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
IP
|
$14.51
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX111787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Blue Shield of California Commercial |
$10.88
|
| Rate for Payer: Blue Shield of California EPN |
$7.75
|
| 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: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$9.68
|
| 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 |
$7.26
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
OP
|
$14.51
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX111787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$8.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| 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: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$10.88
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.68
|
| 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 |
$7.26
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: Riverside University Health 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 |
$7.26
|
| Rate for Payer: United Healthcare All Other HMO |
$7.26
|
| Rate for Payer: United Healthcare HMO Rider |
$7.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
IP
|
$11.46
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Blue Shield of California Commercial |
$8.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.90
|
| Rate for Payer: Blue Shield of California EPN |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| 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 |
$10.56
|
| Rate for Payer: Central Health Plan Commercial |
$9.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| 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 |
$8.02
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$9.74
|
| Rate for Payer: Global Benefits Group Commercial |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$8.60
|
| 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 |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
OP
|
$13.20
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| 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 |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$7.92
|
| Rate for Payer: BCBS Transplant Transplant |
$6.88
|
| Rate for Payer: BCBS Transplant Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.16
|
| 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 |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$8.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.60
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| 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: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$8.60
|
| Rate for Payer: Networks By Design Commercial |
$5.73
|
| Rate for Payer: Networks By Design Commercial |
$6.60
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Prime Health Services Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$4.58
|
| Rate for Payer: Riverside University Health MISP |
$5.28
|
| Rate for Payer: Riverside University Health MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| 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 |
$5.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5.73
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| 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 |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9.74
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
IP
|
$26.03
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Blue Shield of California Commercial |
$27.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,575.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.60
|
| Rate for Payer: Blue Shield of California EPN |
$19.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,121.40
|
| Rate for Payer: Blue Shield of California EPN |
$13.90
|
| Rate for Payer: Blue Shield of California EPN |
$15.38
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Central Health Plan Commercial |
$23.04
|
| Rate for Payer: Central Health Plan Commercial |
$1,680.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.82
|
| Rate for Payer: Central Health Plan Commercial |
$29.34
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA HMO |
$1,470.00
|
| Rate for Payer: Cigna of CA HMO |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$25.68
|
| 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 |
$1,470.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$840.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.67
|
| Rate for Payer: Galaxy Health WC |
$24.48
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Galaxy Health WC |
$31.18
|
| Rate for Payer: Galaxy Health WC |
$1,785.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22.01
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$1,260.00
|
| Rate for Payer: Global Benefits Group Commercial |
$17.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,890.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,400.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.34
|
| 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: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Networks By Design Commercial |
$1,050.00
|
| Rate for Payer: Networks By Design Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$13.02
|
| Rate for Payer: Networks By Design Commercial |
$18.34
|
| Rate for Payer: Prime Health Services Commercial |
$24.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$31.18
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
OP
|
$2,100.00
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$1,890.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,785.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,155.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,155.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.32
|
| 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 |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.33
|
| Rate for Payer: BCBS Transplant Transplant |
$17.28
|
| Rate for Payer: BCBS Transplant Transplant |
$1,260.00
|
| Rate for Payer: BCBS Transplant Transplant |
$22.01
|
| Rate for Payer: BCBS Transplant Transplant |
$15.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$945.00
|
| 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 |
$1,680.00
|
| Rate for Payer: Cigna of CA HMO |
$20.16
|
| Rate for Payer: Cigna of CA HMO |
$1,470.00
|
| Rate for Payer: Cigna of CA HMO |
$18.22
|
| Rate for Payer: Cigna of CA HMO |
$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 |
$1,470.00
|
| Rate for Payer: Cigna of CA PPO |
$25.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,785.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$840.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.41
|
| Rate for Payer: Galaxy Health WC |
$31.18
|
| Rate for Payer: Galaxy Health WC |
$1,785.00
|
| Rate for Payer: Galaxy Health WC |
$24.48
|
| Rate for Payer: Galaxy Health WC |
$22.13
|
| Rate for Payer: Global Benefits Group Commercial |
$1,260.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22.01
|
| Rate for Payer: Global Benefits Group Commercial |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$17.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,890.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,575.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.60
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,400.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.00
|
| 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: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Networks By Design Commercial |
$1,050.00
|
| 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 |
$13.02
|
| Rate for Payer: Prime Health Services Commercial |
$31.18
|
| Rate for Payer: Prime Health Services Commercial |
$24.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.13
|
| Rate for Payer: Riverside University Health MISP |
$14.67
|
| Rate for Payer: Riverside University Health MISP |
$10.41
|
| Rate for Payer: Riverside University Health MISP |
$11.52
|
| Rate for Payer: Riverside University Health MISP |
$840.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.01
|
| 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 |
$1,260.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,260.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.34
|
| Rate for Payer: United Healthcare All Other HMO |
$18.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.02
|
| Rate for Payer: United Healthcare All Other HMO |
$14.40
|
| Rate for Payer: United Healthcare HMO Rider |
$14.40
|
| Rate for Payer: United Healthcare HMO Rider |
$13.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,785.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,785.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24.48
|
| Rate for Payer: Vantage Medical Group Senior |
$31.18
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
OP
|
$452.10
|
|
|
Service Code
|
CPT J0714
|
| Hospital Charge Code |
ERX205130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.42 |
| Max. Negotiated Rate |
$591.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$95.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$591.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$104.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.35
|
| Rate for Payer: BCBS Transplant Transplant |
$271.26
|
| Rate for Payer: Blue Shield of California Commercial |
$118.40
|
| Rate for Payer: Blue Shield of California EPN |
$107.64
|
| Rate for Payer: Caremore Medicare Advantage |
$95.45
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Central Health Plan Commercial |
$361.68
|
| Rate for Payer: Cigna of CA HMO |
$316.47
|
| Rate for Payer: Cigna of CA PPO |
$316.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$95.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$95.45
|
| Rate for Payer: Galaxy Health WC |
$384.28
|
| Rate for Payer: Global Benefits Group Commercial |
$271.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$339.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$156.54
|
| Rate for Payer: IEHP medi-cal |
$157.49
|
| Rate for Payer: IEHP Medicare Advantage |
$95.45
|
| Rate for Payer: Innovage PACE Commercial |
$143.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.90
|
| Rate for Payer: Multiplan Commercial |
$339.08
|
| Rate for Payer: Networks By Design Commercial |
$226.05
|
| Rate for Payer: Prime Health Services Commercial |
$384.28
|
| Rate for Payer: Prime Health Services Medicare |
$101.18
|
| Rate for Payer: Riverside University Health MISP |
$104.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.05
|
| Rate for Payer: United Healthcare All Other HMO |
$226.05
|
| Rate for Payer: United Healthcare HMO Rider |
$226.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.99
|
| Rate for Payer: Vantage Medical Group Senior |
$95.45
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
IP
|
$452.10
|
|
|
Service Code
|
CPT J0714
|
| Hospital Charge Code |
ERX205130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.42 |
| Max. Negotiated Rate |
$406.89 |
| Rate for Payer: Blue Shield of California Commercial |
$339.08
|
| Rate for Payer: Blue Shield of California EPN |
$241.42
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Central Health Plan Commercial |
$361.68
|
| Rate for Payer: Cigna of CA HMO |
$316.47
|
| Rate for Payer: Cigna of CA PPO |
$316.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.84
|
| Rate for Payer: Galaxy Health WC |
$384.28
|
| Rate for Payer: Global Benefits Group Commercial |
$271.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.42
|
| Rate for Payer: Multiplan Commercial |
$339.08
|
| Rate for Payer: Networks By Design Commercial |
$226.05
|
| Rate for Payer: Prime Health Services Commercial |
$384.28
|
|
