|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.44
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
| Rate for Payer: Riverside University Health MISP |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.30
|
| Rate for Payer: United Healthcare All Other HMO |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$3.08
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.41
|
| Rate for Payer: IEHP medi-cal |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Riverside University Health MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
IP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$188.28
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Central Health Plan Commercial |
$200.83
|
| Rate for Payer: Cigna of CA HMO |
$175.73
|
| Rate for Payer: Cigna of CA PPO |
$175.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.42
|
| Rate for Payer: Galaxy Health WC |
$213.38
|
| Rate for Payer: Global Benefits Group Commercial |
$150.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.21
|
| Rate for Payer: Multiplan Commercial |
$188.28
|
| Rate for Payer: Networks By Design Commercial |
$125.52
|
| Rate for Payer: Prime Health Services Commercial |
$213.38
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
OP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.07
|
| Rate for Payer: BCBS Transplant Transplant |
$150.62
|
| Rate for Payer: Blue Shield of California Commercial |
$157.90
|
| Rate for Payer: Blue Shield of California EPN |
$122.76
|
| Rate for Payer: Caremore Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Central Health Plan Commercial |
$200.83
|
| Rate for Payer: Cigna of CA HMO |
$175.73
|
| Rate for Payer: Cigna of CA PPO |
$175.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$213.38
|
| Rate for Payer: Global Benefits Group Commercial |
$150.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$188.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.56
|
| Rate for Payer: IEHP medi-cal |
$3.59
|
| Rate for Payer: IEHP Medicare Advantage |
$2.17
|
| Rate for Payer: Innovage PACE Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$188.28
|
| Rate for Payer: Networks By Design Commercial |
$125.52
|
| Rate for Payer: Prime Health Services Commercial |
$213.38
|
| Rate for Payer: Prime Health Services Medicare |
$2.30
|
| Rate for Payer: Riverside University Health MISP |
$2.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.52
|
| Rate for Payer: United Healthcare All Other HMO |
$125.52
|
| Rate for Payer: United Healthcare HMO Rider |
$125.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.39
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
OP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.74
|
| Rate for Payer: BCBS Transplant Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.92
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.02
|
| Rate for Payer: IEHP medi-cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: Riverside University Health MISP |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
OP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.43
|
| Rate for Payer: BCBS Transplant Transplant |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.85
|
| Rate for Payer: Blue Shield of California EPN |
$5.33
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Central Health Plan Commercial |
$8.71
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$7.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.26
|
| Rate for Payer: Global Benefits Group Commercial |
$6.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.17
|
| Rate for Payer: IEHP medi-cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$8.17
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$9.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.53
|
| Rate for Payer: Riverside University Health MISP |
$4.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO |
$5.44
|
| Rate for Payer: United Healthcare HMO Rider |
$5.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Vantage Medical Group Senior |
$9.26
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.21
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
IP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$8.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Central Health Plan Commercial |
$8.71
|
| Rate for Payer: Cigna of CA HMO |
$7.62
|
| Rate for Payer: Cigna of CA PPO |
$7.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.26
|
| Rate for Payer: Global Benefits Group Commercial |
$6.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$8.17
|
| Rate for Payer: Networks By Design Commercial |
$7.08
|
| Rate for Payer: Prime Health Services Commercial |
$9.26
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
OP
|
$107.99
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: BCBS Transplant Transplant |
$64.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$80.99
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
| Rate for Payer: Riverside University Health MISP |
$43.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.79
|
| Rate for Payer: Vantage Medical Group Senior |
$91.79
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
IP
|
$107.99
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$80.99
|
| Rate for Payer: Blue Shield of California EPN |
$57.67
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Central Health Plan Commercial |
$86.39
|
| Rate for Payer: Cigna of CA HMO |
$75.59
|
| Rate for Payer: Cigna of CA PPO |
$75.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.79
|
| Rate for Payer: Global Benefits Group Commercial |
$64.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: Networks By Design Commercial |
$54.00
|
| Rate for Payer: Prime Health Services Commercial |
$91.79
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
OP
|
$11.88
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.97
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$7.13
|
| Rate for Payer: BCBS Transplant Transplant |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.91
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: IEHP medi-cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| 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 |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Riverside University Health MISP |
$4.75
|
| Rate for Payer: Riverside University Health MISP |
$2.88
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$5.94
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$5.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$10.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.91
|
| 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 |
$3.78
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| 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 |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| 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 |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$10.10
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| 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 |
$12.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$8.94
|
| Rate for Payer: Blue Shield of California EPN |
$6.41
|
| Rate for Payer: Blue Shield of California EPN |
$12.78
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.15
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$11.72
|
| 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 |
$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: Cigna of CA PPO |
$5.38
|
| 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 |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| 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 |
$21.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.92
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| 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
|
|
|
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 |
$20.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.54
|
| 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 |
$4.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.17
|
| 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 |
$14.36
|
| 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: 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 |
$7.54
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$3.46
|
| 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: Central Health Plan Commercial |
$13.40
|
| 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 HMO |
$5.38
|
| Rate for Payer: Cigna of CA PPO |
$11.72
|
| 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 |
$5.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| 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 |
$4.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| 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 |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$6.54
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4.61
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| 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 |
$6.92
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9.00
|
| 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 |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| 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 |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| 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 |
$20.35
|
| 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 |
$6.54
|
| Rate for Payer: Riverside University Health MISP |
$9.58
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$4.61
|
| 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 |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| 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 All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$8.38
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| 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 |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
OP
|
$280.23
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
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 |
$168.13
|
| 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 |
$196.16
|
| 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 |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| 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
|
| 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 |
$168.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.14
|
| 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 |
$140.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.11
|
| Rate for Payer: United Healthcare All Other HMO |
$140.12
|
| Rate for Payer: United Healthcare All Other HMO |
$140.11
|
| 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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 |
$168.14
|
| Rate for Payer: Global Benefits Group Commercial |
$168.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.20
|
| 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 |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| 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
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
IP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 |
$238.19
|
| 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 |
$56.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.05
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| 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
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
OP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
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 |
$168.14
|
| 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 |
$168.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.20
|
| 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 |
$56.05
|
| 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 |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| 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
|
| 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 |
$168.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.14
|
| 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 |
$140.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.11
|
| 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
|
|
|
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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 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 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
