|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 4257116201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 6586250301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.41
|
| Rate for Payer: Cigna of CA PPO |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.49
|
| Rate for Payer: Global Benefits Group Commercial |
$0.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Networks By Design Commercial |
$0.38
|
| Rate for Payer: Prime Health Services Commercial |
$0.49
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET [33228]
|
Facility
|
IP
|
$1.36
|
|
|
Service Code
|
NDC 0781185220
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Adventist Health Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Senior |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 4359822028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.90
|
| Rate for Payer: Blue Shield of California Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.67
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$5.36
|
| Rate for Payer: Cigna of CA HMO |
$4.69
|
| Rate for Payer: Cigna of CA PPO |
$4.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.68
|
| Rate for Payer: Galaxy Health WC |
$5.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$5.03
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Prime Health Services Commercial |
$5.70
|
| Rate for Payer: Riverside University Health System MISP |
$2.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.70
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$8.04
|
|
|
Service Code
|
NDC 4359802028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.45
|
| Rate for Payer: Blue Shield of California EPN |
$4.05
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$5.63
|
| Rate for Payer: Cigna of CA PPO |
$5.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 0781194339
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Central Health Plan Commercial |
$6.47
|
| Rate for Payer: Cigna of CA HMO |
$5.66
|
| Rate for Payer: Cigna of CA PPO |
$5.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Senior |
$3.24
|
| Rate for Payer: Galaxy Health WC |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.88
|
| Rate for Payer: Riverside University Health System MISP |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Other HMO |
$4.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6.88
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$8.09
|
|
|
Service Code
|
NDC 0781194339
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Central Health Plan Commercial |
$6.47
|
| Rate for Payer: Cigna of CA HMO |
$5.66
|
| Rate for Payer: Cigna of CA PPO |
$5.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Senior |
$3.24
|
| Rate for Payer: Galaxy Health WC |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.88
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$8.09
|
|
|
Service Code
|
NDC 0781194382
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Central Health Plan Commercial |
$6.47
|
| Rate for Payer: Cigna of CA HMO |
$5.66
|
| Rate for Payer: Cigna of CA PPO |
$5.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Senior |
$3.24
|
| Rate for Payer: Galaxy Health WC |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.88
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 4359822028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$5.36
|
| Rate for Payer: Cigna of CA HMO |
$4.69
|
| Rate for Payer: Cigna of CA PPO |
$4.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.68
|
| Rate for Payer: EPIC Health Plan Senior |
$2.68
|
| Rate for Payer: Galaxy Health WC |
$5.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$5.03
|
| Rate for Payer: Networks By Design Commercial |
$4.36
|
| Rate for Payer: Prime Health Services Commercial |
$5.70
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.04
|
|
|
Service Code
|
NDC 4359802028
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$5.10
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$5.63
|
| Rate for Payer: Cigna of CA PPO |
$5.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Riverside University Health System MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
NDC 0781194382
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.13
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Central Health Plan Commercial |
$6.47
|
| Rate for Payer: Cigna of CA HMO |
$5.66
|
| Rate for Payer: Cigna of CA PPO |
$5.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Senior |
$3.24
|
| Rate for Payer: Galaxy Health WC |
$6.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$6.07
|
| Rate for Payer: Networks By Design Commercial |
$5.26
|
| Rate for Payer: Prime Health Services Commercial |
$6.88
|
| Rate for Payer: Riverside University Health System MISP |
$3.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Other HMO |
$4.04
|
| Rate for Payer: United Healthcare HMO Rider |
$4.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6.88
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
|
IP
|
$57.60
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Adventist Health Commercial |
$11.52
|
| Rate for Payer: Blue Shield of California Commercial |
$46.20
|
| Rate for Payer: Blue Shield of California EPN |
$29.03
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Central Health Plan Commercial |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$40.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.04
|
| Rate for Payer: EPIC Health Plan Senior |
$23.04
|
| Rate for Payer: Galaxy Health WC |
$48.96
|
| Rate for Payer: Global Benefits Group Commercial |
$34.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$28.80
|
| Rate for Payer: Prime Health Services Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.62
|
| Rate for Payer: United Healthcare All Other HMO |
$21.04
|
| Rate for Payer: United Healthcare HMO Rider |
$20.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.86
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
|
OP
|
$57.60
|
|
|
Service Code
|
HCPCS J0285
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$310.28 |
| Rate for Payer: Adventist Health Commercial |
$11.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$310.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.54
|
| Rate for Payer: Blue Shield of California Commercial |
$66.00
|
| Rate for Payer: Blue Shield of California EPN |
$60.00
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Central Health Plan Commercial |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$40.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.04
|
| Rate for Payer: EPIC Health Plan Senior |
$23.04
|
| Rate for Payer: Galaxy Health WC |
$48.96
|
| Rate for Payer: Global Benefits Group Commercial |
$34.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$28.80
|
| Rate for Payer: Prime Health Services Commercial |
$48.96
|
| Rate for Payer: Riverside University Health System MISP |
$23.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.62
|
| Rate for Payer: United Healthcare All Other HMO |
$21.04
|
| Rate for Payer: United Healthcare HMO Rider |
$20.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.96
|
| Rate for Payer: Vantage Medical Group Senior |
$48.96
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
|
IP
|
$393.43
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.69 |
| Max. Negotiated Rate |
$354.09 |
| Rate for Payer: Adventist Health Commercial |
$78.69
|
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Adventist Health Commercial |
$57.29
|
| Rate for Payer: Blue Shield of California Commercial |
$315.53
|
| Rate for Payer: Blue Shield of California Commercial |
$245.17
|
| Rate for Payer: Blue Shield of California Commercial |
$229.72
|
| Rate for Payer: Blue Shield of California EPN |
$144.37
|
| Rate for Payer: Blue Shield of California EPN |
$198.29
|
| Rate for Payer: Blue Shield of California EPN |
$154.07
|
| Rate for Payer: Cash Price |
$177.04
|
| Rate for Payer: Cash Price |
$128.90
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Central Health Plan Commercial |
$244.56
|
| Rate for Payer: Central Health Plan Commercial |
$229.15
|
| Rate for Payer: Central Health Plan Commercial |
$314.74
|
| Rate for Payer: Cigna of CA HMO |
$275.40
|
| Rate for Payer: Cigna of CA HMO |
$200.51
|
| Rate for Payer: Cigna of CA HMO |
$213.99
|
| Rate for Payer: Cigna of CA PPO |
$275.40
|
| Rate for Payer: Cigna of CA PPO |
$213.99
|
| Rate for Payer: Cigna of CA PPO |
$200.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.37
|
| Rate for Payer: EPIC Health Plan Senior |
$122.28
|
| Rate for Payer: EPIC Health Plan Senior |
$114.58
|
| Rate for Payer: EPIC Health Plan Senior |
$157.37
|
| Rate for Payer: Galaxy Health WC |
$259.85
|
| Rate for Payer: Galaxy Health WC |
$243.47
|
| Rate for Payer: Galaxy Health WC |
$334.42
|
| Rate for Payer: Global Benefits Group Commercial |
$236.06
|
| Rate for Payer: Global Benefits Group Commercial |
$183.42
|
| Rate for Payer: Global Benefits Group Commercial |
$171.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$181.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$232.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.29
|
| Rate for Payer: Multiplan Commercial |
$295.07
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Networks By Design Commercial |
$196.72
|
| Rate for Payer: Networks By Design Commercial |
$143.22
|
| Rate for Payer: Networks By Design Commercial |
$152.85
|
| Rate for Payer: Prime Health Services Commercial |
$259.85
|
| Rate for Payer: Prime Health Services Commercial |
$334.42
|
| Rate for Payer: Prime Health Services Commercial |
$243.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.73
|
| Rate for Payer: United Healthcare All Other HMO |
$111.67
|
| Rate for Payer: United Healthcare All Other HMO |
$104.64
|
| Rate for Payer: United Healthcare All Other HMO |
$143.72
|
| Rate for Payer: United Healthcare HMO Rider |
$102.37
|
| Rate for Payer: United Healthcare HMO Rider |
$109.26
|
| Rate for Payer: United Healthcare HMO Rider |
$140.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.81
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
|
OP
|
$393.43
|
|
|
Service Code
|
HCPCS J0289
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$354.09 |
| Rate for Payer: Adventist Health Commercial |
$78.69
|
| Rate for Payer: Adventist Health Commercial |
$57.29
|
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.64
|
| Rate for Payer: Blue Shield of California Commercial |
$67.25
|
| Rate for Payer: Blue Shield of California Commercial |
$67.25
|
| Rate for Payer: Blue Shield of California Commercial |
$67.25
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Blue Shield of California EPN |
$61.14
|
| Rate for Payer: Cash Price |
$177.04
|
| Rate for Payer: Cash Price |
$128.90
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cash Price |
$128.90
|
| Rate for Payer: Cash Price |
$177.04
|
| Rate for Payer: Central Health Plan Commercial |
$229.15
|
| Rate for Payer: Central Health Plan Commercial |
$314.74
|
| Rate for Payer: Central Health Plan Commercial |
$244.56
|
| Rate for Payer: Cigna of CA HMO |
$213.99
|
| Rate for Payer: Cigna of CA HMO |
$200.51
|
| Rate for Payer: Cigna of CA HMO |
$275.40
|
| Rate for Payer: Cigna of CA PPO |
$275.40
|
| Rate for Payer: Cigna of CA PPO |
$213.99
|
| Rate for Payer: Cigna of CA PPO |
$200.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.75
|
| Rate for Payer: EPIC Health Plan Senior |
$21.84
|
| Rate for Payer: EPIC Health Plan Senior |
$21.84
|
| Rate for Payer: EPIC Health Plan Senior |
$21.84
|
| Rate for Payer: Galaxy Health WC |
$243.47
|
| Rate for Payer: Galaxy Health WC |
$334.42
|
| Rate for Payer: Galaxy Health WC |
$259.85
|
| Rate for Payer: Global Benefits Group Commercial |
$236.06
|
| Rate for Payer: Global Benefits Group Commercial |
$171.86
|
| Rate for Payer: Global Benefits Group Commercial |
$183.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$181.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: Multiplan Commercial |
$295.07
|
| Rate for Payer: Networks By Design Commercial |
$143.22
|
| Rate for Payer: Networks By Design Commercial |
$196.72
|
| Rate for Payer: Networks By Design Commercial |
$152.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.85
|
| Rate for Payer: Prime Health Services Commercial |
$259.85
|
| Rate for Payer: Prime Health Services Commercial |
$334.42
|
| Rate for Payer: Prime Health Services Commercial |
$243.47
|
| Rate for Payer: Prime Health Services Medicare |
$21.04
|
| Rate for Payer: Prime Health Services Medicare |
$21.04
|
| Rate for Payer: Prime Health Services Medicare |
$21.04
|
| Rate for Payer: Riverside University Health System MISP |
$21.84
|
| Rate for Payer: Riverside University Health System MISP |
$21.84
|
| Rate for Payer: Riverside University Health System MISP |
$21.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.65
|
| Rate for Payer: United Healthcare All Other HMO |
$104.64
|
| Rate for Payer: United Healthcare All Other HMO |
$143.72
|
| Rate for Payer: United Healthcare All Other HMO |
$111.67
|
| Rate for Payer: United Healthcare HMO Rider |
$140.61
|
| Rate for Payer: United Healthcare HMO Rider |
$109.26
|
| Rate for Payer: United Healthcare HMO Rider |
$102.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.84
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
|
OP
|
$4.56
|
|
|
Service Code
|
NDC 9994080241
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.89
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Central Health Plan Commercial |
$3.65
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
| Rate for Payer: Riverside University Health System MISP |
$1.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 9994080241
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.66
|
| Rate for Payer: Blue Shield of California EPN |
$2.30
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Central Health Plan Commercial |
$3.65
|
| Rate for Payer: Cigna of CA HMO |
$3.19
|
| Rate for Payer: Cigna of CA PPO |
$3.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: EPIC Health Plan Senior |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$3.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Networks By Design Commercial |
$2.96
|
| Rate for Payer: Prime Health Services Commercial |
$3.88
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Central Health Plan Commercial |
$66.22
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Galaxy Health WC |
$70.35
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$49.66
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$41.38
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$70.35
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Riverside University Health System MISP |
$33.11
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Riverside University Health System MISP |
$31.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.06
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$30.24
|
| Rate for Payer: United Healthcare All Other HMO |
$28.49
|
| Rate for Payer: United Healthcare HMO Rider |
$29.58
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare HMO Rider |
$27.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$70.35
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California Commercial |
$66.38
|
| Rate for Payer: Blue Shield of California Commercial |
$62.56
|
| Rate for Payer: Blue Shield of California EPN |
$39.31
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Blue Shield of California EPN |
$41.72
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Central Health Plan Commercial |
$66.22
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA HMO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$57.94
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$33.11
|
| Rate for Payer: EPIC Health Plan Senior |
$31.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$70.35
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Global Benefits Group Commercial |
$49.66
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$41.38
|
| Rate for Payer: Prime Health Services Commercial |
$70.35
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.06
|
| Rate for Payer: United Healthcare All Other HMO |
$30.24
|
| Rate for Payer: United Healthcare All Other HMO |
$28.49
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$27.88
|
| Rate for Payer: United Healthcare HMO Rider |
$29.58
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.55
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5.32
|
| Rate for Payer: Blue Shield of California Commercial |
$4.66
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Central Health Plan Commercial |
$5.30
|
| Rate for Payer: Central Health Plan Commercial |
$4.65
|
| 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 |
$4.07
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$4.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.65
|
| Rate for Payer: EPIC Health Plan Senior |
$2.32
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$4.94
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Networks By Design Commercial |
$3.31
|
| Rate for Payer: Prime Health Services Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$4.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.49
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$2.08
|
| Rate for Payer: United Healthcare HMO Rider |
$2.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$4.65
|
| Rate for Payer: Central Health Plan Commercial |
$5.30
|
| Rate for Payer: Central Health Plan Commercial |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$4.07
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$4.07
|
| Rate for Payer: Cigna of CA PPO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.65
|
| Rate for Payer: EPIC Health Plan Senior |
$2.32
|
| Rate for Payer: Galaxy Health WC |
$6.12
|
| Rate for Payer: Galaxy Health WC |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$4.94
|
| Rate for Payer: Global Benefits Group Commercial |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.98
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Networks By Design Commercial |
$3.31
|
| Rate for Payer: Networks By Design Commercial |
$2.90
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.12
|
| Rate for Payer: Prime Health Services Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$4.94
|
| Rate for Payer: Riverside University Health System MISP |
$2.65
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Riverside University Health System MISP |
$2.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.49
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2.37
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.94
|
| Rate for Payer: Vantage Medical Group Senior |
$5.64
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
IP
|
$8.53
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California Commercial |
$12.90
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Central Health Plan Commercial |
$6.82
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$5.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$3.38
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Central Health Plan Commercial |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$6.82
|
| Rate for Payer: Cigna of CA HMO |
$11.26
|
| Rate for Payer: Cigna of CA HMO |
$5.97
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$11.26
|
| Rate for Payer: Cigna of CA PPO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$5.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$1.68
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Galaxy Health WC |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$13.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Global Benefits Group Commercial |
$2.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$8.04
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Prime Health Services Commercial |
$3.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$1.68
|
| Rate for Payer: Riverside University Health System MISP |
$3.41
|
| Rate for Payer: Riverside University Health System MISP |
$6.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3.05
|
| Rate for Payer: United Healthcare HMO Rider |
$5.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781214501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare HMO Rider |
$0.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781214501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.31
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Central Health Plan Commercial |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.43
|
| Rate for Payer: Cigna of CA PPO |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.25
|
| Rate for Payer: Galaxy Health WC |
$0.53
|
| Rate for Payer: Global Benefits Group Commercial |
$0.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Networks By Design Commercial |
$0.40
|
| Rate for Payer: Prime Health Services Commercial |
$0.53
|
|
