|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 57237-099-60
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
IP
|
$1.45
|
|
|
Service Code
|
NDC 68001-362-06
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Senior |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
|
|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
OP
|
$1.45
|
|
|
Service Code
|
NDC 68001-362-06
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.23
|
| Rate for Payer: Dignity Health Senior |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.90
|
| Rate for Payer: Heritage Provider Network Senior |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1.23
|
|
|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 65862-177-60
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 65862-177-60
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
CEFDINIR 300 MG CAPSULE [22289]
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 57237-099-60
|
| Hospital Charge Code |
ERX22289
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
ERX223402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$196.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.41
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
ERX223402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Senior |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.02
|
| Rate for Payer: Heritage Provider Network Senior |
$250.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$196.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1750496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.48
|
| Rate for Payer: Dignity Health Senior |
$5.15
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$5.14
|
| Rate for Payer: Vantage Medical Group Senior |
$5.15
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]
|
Facility
IP
|
$6.06
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1750496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Adventist Health Commercial |
$1.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.16
|
| Rate for Payer: Heritage Provider Network Senior |
$4.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.02
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1720938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.25
|
| Rate for Payer: Dignity Health Senior |
$11.06
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.58
|
| Rate for Payer: Heritage Provider Network Senior |
$6.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]
|
Facility
IP
|
$12.06
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
1720938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.94
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.96
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$7.96
|
| Rate for Payer: Heritage Provider Network Senior |
$8.16
|
| Rate for Payer: Heritage Provider Network Senior |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.35
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
IP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Senior |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
OP
|
$0.59
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDC4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
NDG4081790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.93 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.55
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
IP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.44 |
| Max. Negotiated Rate |
$188.28 |
| Rate for Payer: Adventist Health Commercial |
$50.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$172.46
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.95
|
| Rate for Payer: Heritage Provider Network Senior |
$169.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.76
|
| Rate for Payer: Multiplan Commercial |
$188.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.87
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
OP
|
$251.04
|
|
|
Service Code
|
CPT J0699
|
| Hospital Charge Code |
ERX227170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$188.28 |
| Rate for Payer: Adventist Health Commercial |
$50.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$172.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.03
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cash Price |
$112.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Senior |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.23
|
| Rate for Payer: Heritage Provider Network Senior |
$116.23
|
| Rate for Payer: Humana Medicare |
$2.17
|
| Rate for Payer: IEHP Medi-Cal |
$10.34
|
| Rate for Payer: IEHP Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.74
|
| Rate for Payer: Multiplan Commercial |
$188.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.39
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$91.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.39
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
IP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.17 |
| Rate for Payer: Adventist Health Commercial |
$2.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.48
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.37
|
| Rate for Payer: Heritage Provider Network Senior |
$7.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$8.17
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.51
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.43
|
| Rate for Payer: Heritage Provider Network Senior |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
OP
|
$10.89
|
|
|
Service Code
|
NDC 27437-206-02
|
| Hospital Charge Code |
NDG81816
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Adventist Health Commercial |
$2.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.76
|
| Rate for Payer: Blue Shield of California EPN |
$6.39
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.26
|
| Rate for Payer: Dignity Health Senior |
$9.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Senior |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$8.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.26
|
| Rate for Payer: Vantage Medical Group Senior |
$9.26
|
|
