|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
1721179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$8.04
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.28
|
| 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 |
$3.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.21
|
| Rate for Payer: Heritage Provider Network Senior |
$16.21
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$11.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.57
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
OP
|
$7.69
|
|
|
Service Code
|
CPT J0694
|
| Hospital Charge Code |
ERX9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$34.49 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.51
|
| Rate for Payer: Cash Price |
$7.54
|
| 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 |
$3.46
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| 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 |
$6.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: Dignity Health Senior |
$20.35
|
| Rate for Payer: Dignity Health Senior |
$6.54
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$11.08
|
| Rate for Payer: Heritage Provider Network Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$17.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| 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 |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6.54
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
|
|
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 |
$0.81 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.08
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
|
|
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 |
$0.81 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.63
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.81
|
| Rate for Payer: Dignity Health Senior |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Senior |
$1.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.81
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
IP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$210.16 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Adventist Health Commercial |
$56.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.51
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.71
|
| Rate for Payer: Heritage Provider Network Senior |
$189.71
|
| Rate for Payer: Heritage Provider Network Senior |
$189.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
|
|
CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION [107670]
|
Facility
|
OP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$210.16 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Adventist Health Commercial |
$56.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.73
|
| 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: Cigna of CA HMO/PPO |
$128.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Senior |
$4.22
|
| Rate for Payer: Dignity Health Senior |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.75
|
| Rate for Payer: Heritage Provider Network Senior |
$129.75
|
| Rate for Payer: Heritage Provider Network Senior |
$129.74
|
| Rate for Payer: Humana Medicare |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.09
|
| Rate for Payer: TriValley Medical Group Senior |
$112.09
|
| Rate for Payer: TriValley Medical Group Senior |
$112.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
OP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$210.16 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Adventist Health Commercial |
$56.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.73
|
| 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: Cigna of CA HMO/PPO |
$128.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.22
|
| Rate for Payer: Dignity Health Senior |
$4.22
|
| Rate for Payer: Dignity Health Senior |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.75
|
| Rate for Payer: Heritage Provider Network Senior |
$129.75
|
| Rate for Payer: Heritage Provider Network Senior |
$129.74
|
| Rate for Payer: Humana Medicare |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.09
|
| Rate for Payer: TriValley Medical Group Senior |
$112.09
|
| Rate for Payer: TriValley Medical Group Senior |
$112.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.22
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
| Rate for Payer: Vantage Medical Group Senior |
$3.84
|
|
|
CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION [107671]
|
Facility
|
IP
|
$280.22
|
|
|
Service Code
|
CPT J0712
|
| Hospital Charge Code |
ERX107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$210.16 |
| Rate for Payer: Adventist Health Commercial |
$56.04
|
| Rate for Payer: Adventist Health Commercial |
$56.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.51
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.71
|
| Rate for Payer: Heritage Provider Network Senior |
$189.71
|
| Rate for Payer: Heritage Provider Network Senior |
$189.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.06
|
| Rate for Payer: Multiplan Commercial |
$210.16
|
| Rate for Payer: Multiplan Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.62
|
|
|
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 |
$0.93 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
|
|
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 |
$0.93 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Senior |
$4.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Senior |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
CEFTAZIDIME 1 GRAM INTRAVENOUS SOLUTION [27290]
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX27290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.07
|
| Rate for Payer: Dignity Health Senior |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Senior |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.39
|
| 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 |
$1.29 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.91
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.39
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4081895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.07
|
| Rate for Payer: Dignity Health Senior |
$4.59
|
| Rate for Payer: Dignity Health Senior |
$3.32
|
| Rate for Payer: Dignity Health Senior |
$4.35
|
| Rate for Payer: Dignity Health Senior |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$6.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Senior |
$2.86
|
| Rate for Payer: TriValley Medical Group Senior |
$2.05
|
| Rate for Payer: TriValley Medical Group Senior |
$1.56
|
| Rate for Payer: TriValley Medical Group Senior |
$2.50
|
| Rate for Payer: TriValley Medical Group Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$6.07
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (200 MG/ML RECONST) [4081895]
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX4081895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: Heritage Provider Network Senior |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.39
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.08
|
|
|
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION [9474]
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1722013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$0.78
|
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$4.35
|
| Rate for Payer: Dignity Health Senior |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$3.32
|
| Rate for Payer: Dignity Health Senior |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Senior |
$1.56
|
| Rate for Payer: TriValley Medical Group Senior |
$2.05
|
| Rate for Payer: TriValley Medical Group Senior |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.59
|
| Rate for Payer: Vantage Medical Group Senior |
$3.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.35
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
|
IP
|
$14.51
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX111787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.97
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.85
|
|
|
CEFTAZIDIME 2 GRAM INTRAVENOUS SOLUTION [111787]
|
Facility
|
OP
|
$14.51
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX111787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Senior |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.72
|
| Rate for Payer: Heritage Provider Network Senior |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.63
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.80
|
| Rate for Payer: TriValley Medical Group Senior |
$5.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.29
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$9.74
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$6.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5.31
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.58
|
| Rate for Payer: TriValley Medical Group Senior |
$4.58
|
| Rate for Payer: TriValley Medical Group Senior |
$5.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Vantage Medical Group Senior |
$9.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION [9476]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
ERX9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Adventist Health Commercial |
$2.29
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.87
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Senior |
$8.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
|
OP
|
$36.68
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Adventist Health Commercial |
$7.34
|
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,442.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,785.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,155.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,575.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.18
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,785.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,785.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.18
|
| Rate for Payer: Dignity Health Senior |
$22.13
|
| Rate for Payer: Dignity Health Senior |
$31.18
|
| Rate for Payer: Dignity Health Senior |
$1,785.00
|
| Rate for Payer: Dignity Health Senior |
$24.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,344.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$972.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.98
|
| Rate for Payer: Heritage Provider Network Senior |
$972.30
|
| Rate for Payer: Heritage Provider Network Senior |
$12.05
|
| Rate for Payer: Heritage Provider Network Senior |
$13.33
|
| Rate for Payer: Heritage Provider Network Senior |
$16.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,012.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Senior |
$11.52
|
| Rate for Payer: TriValley Medical Group Senior |
$840.00
|
| Rate for Payer: TriValley Medical Group Senior |
$10.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$765.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$701.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,785.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$31.18
|
| Rate for Payer: Vantage Medical Group Senior |
$24.48
|
| Rate for Payer: Vantage Medical Group Senior |
$1,785.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
|
|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
|
IP
|
$36.68
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$27.51 |
| Rate for Payer: Adventist Health Commercial |
$7.34
|
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,442.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.20
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,421.70
|
| Rate for Payer: Heritage Provider Network Senior |
$17.62
|
| Rate for Payer: Heritage Provider Network Senior |
$19.50
|
| Rate for Payer: Heritage Provider Network Senior |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$765.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$701.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.25
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
|
OP
|
$452.10
|
|
|
Service Code
|
CPT J0714
|
| Hospital Charge Code |
ERX205130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$339.08 |
| Rate for Payer: Adventist Health Commercial |
$90.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$234.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.23
|
| Rate for Payer: Blue Shield of California Commercial |
$91.49
|
| Rate for Payer: Blue Shield of California EPN |
$91.49
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.99
|
| Rate for Payer: Dignity Health Senior |
$104.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$95.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.32
|
| Rate for Payer: Heritage Provider Network Senior |
$209.32
|
| Rate for Payer: Humana Medicare |
$95.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$95.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.27
|
| Rate for Payer: Multiplan Commercial |
$339.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.84
|
| Rate for Payer: TriValley Medical Group Senior |
$180.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.99
|
| Rate for Payer: Vantage Medical Group Senior |
$95.45
|
|
|
CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION [205130]
|
Facility
|
IP
|
$452.10
|
|
|
Service Code
|
CPT J0714
|
| Hospital Charge Code |
ERX205130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$339.08 |
| Rate for Payer: Adventist Health Commercial |
$90.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.59
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.07
|
| Rate for Payer: Heritage Provider Network Senior |
$306.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.02
|
| Rate for Payer: Multiplan Commercial |
$339.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.05
|
|
