|
CEFTRIAXONE 500 MG INJECTION (IM) [4080778]
|
Facility
IP
|
$1.50
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$3.50
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$3.07
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.75
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$2.63
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$2.19
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Prime Health Services Commercial |
$3.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]
|
Facility
OP
|
$2.16
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.90
|
| Rate for Payer: BCBS Transplant Transplant |
$0.70
|
| Rate for Payer: BCBS Transplant Transplant |
$1.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Central Health Plan Commercial |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.62
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Riverside University Health MISP |
$0.46
|
| Rate for Payer: Riverside University Health MISP |
$0.86
|
| Rate for Payer: Riverside University Health MISP |
$0.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.84
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1.84
|
|
|
CEFTRIAXONE 500 MG SOLUTION FOR INJECTION [9490]
|
Facility
IP
|
$1.50
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Central Health Plan Commercial |
$1.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.93
|
| Rate for Payer: Central Health Plan Commercial |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Cigna of CA PPO |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$1.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.99
|
| Rate for Payer: Prime Health Services Commercial |
$1.84
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
|
|
CEFTRIAXONE/H2O IV INFUSION 100 MG/ML [4081845]
|
Facility
OP
|
$19.06
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4081845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: BCBS Transplant Transplant |
$20.16
|
| Rate for Payer: BCBS Transplant Transplant |
$11.44
|
| Rate for Payer: BCBS Transplant Transplant |
$24.12
|
| Rate for Payer: BCBS Transplant Transplant |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: Central Health Plan Commercial |
$32.16
|
| Rate for Payer: Central Health Plan Commercial |
$15.25
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$13.34
|
| Rate for Payer: Cigna of CA HMO |
$14.55
|
| Rate for Payer: Cigna of CA HMO |
$28.14
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: Cigna of CA PPO |
$28.14
|
| Rate for Payer: Cigna of CA PPO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$13.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Galaxy Health WC |
$16.20
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$34.17
|
| Rate for Payer: Global Benefits Group Commercial |
$24.12
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Global Benefits Group Commercial |
$11.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.30
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$30.15
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Networks By Design Commercial |
$20.10
|
| Rate for Payer: Networks By Design Commercial |
$9.53
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Prime Health Services Commercial |
$34.17
|
| Rate for Payer: Riverside University Health MISP |
$13.44
|
| Rate for Payer: Riverside University Health MISP |
$8.31
|
| Rate for Payer: Riverside University Health MISP |
$7.62
|
| Rate for Payer: Riverside University Health MISP |
$16.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.10
|
| Rate for Payer: United Healthcare All Other HMO |
$20.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.39
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10.39
|
| Rate for Payer: United Healthcare HMO Rider |
$20.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.20
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$34.17
|
|
|
CEFTRIAXONE/H2O IV INFUSION 100 MG/ML [4081845]
|
Facility
IP
|
$20.78
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4081845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Blue Shield of California Commercial |
$15.58
|
| Rate for Payer: Blue Shield of California Commercial |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$30.15
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$17.94
|
| Rate for Payer: Blue Shield of California EPN |
$11.10
|
| Rate for Payer: Blue Shield of California EPN |
$21.47
|
| Rate for Payer: Blue Shield of California EPN |
$10.18
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: Central Health Plan Commercial |
$26.88
|
| Rate for Payer: Central Health Plan Commercial |
$32.16
|
| Rate for Payer: Central Health Plan Commercial |
$15.25
|
| Rate for Payer: Cigna of CA HMO |
$23.52
|
| Rate for Payer: Cigna of CA HMO |
$28.14
|
| Rate for Payer: Cigna of CA HMO |
$14.55
|
| Rate for Payer: Cigna of CA HMO |
$13.34
|
| Rate for Payer: Cigna of CA PPO |
$13.34
|
| Rate for Payer: Cigna of CA PPO |
$28.14
|
| Rate for Payer: Cigna of CA PPO |
$14.55
|
| Rate for Payer: Cigna of CA PPO |
$23.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Galaxy Health WC |
$34.17
|
| Rate for Payer: Galaxy Health WC |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$16.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11.44
|
| Rate for Payer: Global Benefits Group Commercial |
$24.12
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Global Benefits Group Commercial |
$20.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.04
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: Multiplan Commercial |
$30.15
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$15.58
|
| Rate for Payer: Networks By Design Commercial |
$9.53
|
| Rate for Payer: Networks By Design Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$20.10
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Prime Health Services Commercial |
$34.17
|
| Rate for Payer: Prime Health Services Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Prime Health Services Commercial |
$16.20
|
|
|
CEFTRIAXONE (ROCEPHIN) 1G/10 ML FROZEN SYRINGE [4081848]
|
Facility
IP
|
$0.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
CEFTRIAXONE (ROCEPHIN) 1G/10 ML FROZEN SYRINGE [4081848]
|
Facility
OP
|
$0.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.36
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
CEFTRIAXONE (ROCEPHIN) 2G/20 ML FROZEN SYRINGE [4081846]
|
Facility
OP
|
$5.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.77
|
| Rate for Payer: BCBS Transplant Transplant |
$3.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2.02
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.05
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
| Rate for Payer: Riverside University Health MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
|
|
CEFTRIAXONE (ROCEPHIN) 2G/20 ML FROZEN SYRINGE [4081846]
|
Facility
IP
|
$5.40
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
NDC4081846
|
|
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 EPN |
$2.88
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.59
|
| Rate for Payer: Global Benefits Group Commercial |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$4.59
|
|
|
CEFUROXIME AXETIL 250 MG TABLET [9495]
|
Facility
IP
|
$0.51
|
|
|
Service Code
|
NDC 67877-215-20
|
| Hospital Charge Code |
1711599
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
CEFUROXIME AXETIL 250 MG TABLET [9495]
|
Facility
OP
|
$0.51
|
|
|
Service Code
|
NDC 67877-215-20
|
| Hospital Charge Code |
1711599
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: BCBS Transplant Transplant |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.41
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.38
|
| Rate for Payer: IEHP medi-cal |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: Riverside University Health MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [111827]
|
Facility
IP
|
$7.02
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
1720555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4.88
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Central Health Plan Commercial |
$5.62
|
| Rate for Payer: Central Health Plan Commercial |
$5.21
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA PPO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: Galaxy Health WC |
$5.53
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
| Rate for Payer: Networks By Design Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$3.51
|
| Rate for Payer: Prime Health Services Commercial |
$5.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
|
|
CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION [111827]
|
Facility
OP
|
$6.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
1720555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.62
|
| Rate for Payer: BCBS Transplant Transplant |
$3.91
|
| Rate for Payer: BCBS Transplant Transplant |
$4.21
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Central Health Plan Commercial |
$5.21
|
| Rate for Payer: Central Health Plan Commercial |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$4.91
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$4.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.60
|
| Rate for Payer: Galaxy Health WC |
$5.97
|
| Rate for Payer: Galaxy Health WC |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.91
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.26
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$3.51
|
| Rate for Payer: Prime Health Services Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$5.53
|
| Rate for Payer: Riverside University Health MISP |
$2.60
|
| Rate for Payer: Riverside University Health MISP |
$2.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3.26
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.97
|
| Rate for Payer: Vantage Medical Group Senior |
$5.53
|
| Rate for Payer: Vantage Medical Group Senior |
$5.97
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]
|
Facility
IP
|
$3.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
ERX1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.16 |
| Rate for Payer: Blue Shield of California Commercial |
$2.63
|
| Rate for Payer: Blue Shield of California EPN |
$1.87
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
|
|
CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION [1465]
|
Facility
OP
|
$3.51
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
ERX1465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Central Health Plan Commercial |
$2.81
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.40
|
| Rate for Payer: Galaxy Health WC |
$2.98
|
| Rate for Payer: Global Benefits Group Commercial |
$2.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.63
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$2.63
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.98
|
| Rate for Payer: Riverside University Health MISP |
$1.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Vantage Medical Group Senior |
$2.98
|
|
|
CEFUROXIME (ZINACEF) 1.5G/15ML FROZEN SYRINGE [4081783]
|
Facility
IP
|
$6.36
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
NDC4081783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Blue Shield of California Commercial |
$4.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.40
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
|
|
CEFUROXIME (ZINACEF) 1.5G/15ML FROZEN SYRINGE [4081783]
|
Facility
OP
|
$6.36
|
|
|
Service Code
|
CPT J0697
|
| Hospital Charge Code |
NDC4081783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.62
|
| Rate for Payer: BCBS Transplant Transplant |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Central Health Plan Commercial |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$4.45
|
| Rate for Payer: Cigna of CA PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$5.41
|
| Rate for Payer: Global Benefits Group Commercial |
$3.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.77
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.77
|
| Rate for Payer: Networks By Design Commercial |
$3.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.41
|
| Rate for Payer: Riverside University Health MISP |
$2.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO |
$3.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$1.45
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: BCBS Transplant Transplant |
$0.87
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.09
|
| Rate for Payer: IEHP medi-cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.87
|
| Rate for Payer: Riverside University Health MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.73
|
| Rate for Payer: United Healthcare All Other HMO |
$0.73
|
| Rate for Payer: United Healthcare HMO Rider |
$0.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1.23
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$1.74
|
|
|
Service Code
|
NDC 60687-436-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.93
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Central Health Plan Commercial |
$1.39
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Galaxy Health WC |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$1.30
|
| Rate for Payer: Networks By Design Commercial |
$1.13
|
| Rate for Payer: Prime Health Services Commercial |
$1.48
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: IEHP medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Riverside University Health MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 33342-156-11
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$11.44
|
|
|
Service Code
|
NDC 0025-1520-34
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Blue Shield of California Commercial |
$8.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Central Health Plan Commercial |
$9.15
|
| Rate for Payer: Cigna of CA HMO |
$8.01
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: Galaxy Health WC |
$9.72
|
| Rate for Payer: Global Benefits Group Commercial |
$6.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$8.58
|
| Rate for Payer: Networks By Design Commercial |
$7.44
|
| Rate for Payer: Prime Health Services Commercial |
$9.72
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
OP
|
$11.44
|
|
|
Service Code
|
NDC 0025-1520-34
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: BCBS Transplant Transplant |
$6.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Central Health Plan Commercial |
$9.15
|
| Rate for Payer: Cigna of CA HMO |
$8.01
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.58
|
| Rate for Payer: Galaxy Health WC |
$9.72
|
| Rate for Payer: Global Benefits Group Commercial |
$6.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.58
|
| Rate for Payer: IEHP medi-cal |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$8.58
|
| Rate for Payer: Networks By Design Commercial |
$7.44
|
| Rate for Payer: Prime Health Services Commercial |
$9.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.86
|
| Rate for Payer: Riverside University Health MISP |
$4.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.72
|
| Rate for Payer: United Healthcare All Other HMO |
$5.72
|
| Rate for Payer: United Healthcare HMO Rider |
$5.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.72
|
| Rate for Payer: Vantage Medical Group Senior |
$9.72
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$0.36
|
|
|
Service Code
|
NDC 62332-141-31
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.29
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
CELECOXIB 100 MG CAPSULE [24500]
|
Facility
IP
|
$1.45
|
|
|
Service Code
|
NDC 0904-6502-61
|
| Hospital Charge Code |
1710870
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Central Health Plan Commercial |
$1.16
|
| Rate for Payer: Cigna of CA HMO |
$1.02
|
| Rate for Payer: Cigna of CA PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$1.23
|
| Rate for Payer: Global Benefits Group Commercial |
$0.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Networks By Design Commercial |
$0.94
|
| Rate for Payer: Prime Health Services Commercial |
$1.23
|
|
