|
CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION (100MG/ML IVPB) [9478]
|
Facility
OP
|
$26.03
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
1750248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: Adventist Health Commercial |
$5.21
|
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Adventist Health Commercial |
$7.34
|
| 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 |
$19.79
|
| 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 |
$25.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,785.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,155.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,575.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.51
|
| 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 |
$945.00
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,785.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,785.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.13
|
| Rate for Payer: Dignity Health Senior |
$1,785.00
|
| Rate for Payer: Dignity Health Senior |
$22.13
|
| Rate for Payer: Dignity Health Senior |
$24.48
|
| Rate for Payer: Dignity Health Senior |
$31.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$972.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.33
|
| 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: Heritage Provider Network Senior |
$972.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,012.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
| 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: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| 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+ |
$12.25
|
| 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: Vantage Medical Group Medi-Cal |
$22.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,785.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.48
|
| Rate for Payer: Vantage Medical Group Senior |
$22.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1,785.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24.48
|
| Rate for Payer: Vantage Medical Group Senior |
$31.18
|
|
|
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 |
$19.79
|
| 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: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$11.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.06
|
| 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: Heritage Provider Network Commercial |
$17.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.83
|
| 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 |
$1,421.70
|
| 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 |
$380.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| 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 |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$27.51
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.50
|
| 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 All Other HMO/non HMO |
$9.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$701.61
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$119.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$104.99
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$155.86
|
| Rate for Payer: 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 |
$104.99
|
| Rate for Payer: TriValley Medical Group Senior |
$95.45
|
| 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
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
OP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.49
|
| 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 |
$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 |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Senior |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| 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 |
$0.10
|
| 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 |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CEFTAZIDIME (FORTAZ) 1G/10ML FROZEN SYRINGE [4081276]
|
Facility
IP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| 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 |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
OP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$14.13 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.49
|
| 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 |
$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 |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.49
|
| Rate for Payer: Dignity Health Senior |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| 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 |
$0.10
|
| 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 |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.49
|
| Rate for Payer: Vantage Medical Group Senior |
$0.49
|
|
|
CEFTAZIDIME (FORTAZ) 2G/20ML FROZEN SYRINGE [4081279]
|
Facility
IP
|
$0.58
|
|
|
Service Code
|
CPT J0713
|
| Hospital Charge Code |
NDC4081279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.40
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Senior |
$0.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| 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 |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.19
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
IP
|
$173.23
|
|
|
Service Code
|
CPT J0695
|
| Hospital Charge Code |
ERX208439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$129.92 |
| Rate for Payer: Adventist Health Commercial |
$34.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.01
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.28
|
| Rate for Payer: Heritage Provider Network Senior |
$117.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.31
|
| Rate for Payer: Multiplan Commercial |
$129.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$57.88
|
|
|
CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION [208439]
|
Facility
OP
|
$173.23
|
|
|
Service Code
|
CPT J0695
|
| Hospital Charge Code |
ERX208439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$129.92 |
| Rate for Payer: Adventist Health Commercial |
$34.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.70
|
| Rate for Payer: Blue Shield of California EPN |
$6.70
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.11
|
| Rate for Payer: Dignity Health Senior |
$8.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.21
|
| Rate for Payer: Heritage Provider Network Senior |
$80.21
|
| Rate for Payer: Humana Medicare |
$7.37
|
| Rate for Payer: IEHP Medicare Advantage |
$7.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.29
|
| Rate for Payer: Multiplan Commercial |
$129.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.11
|
| Rate for Payer: TriValley Medical Group Senior |
$7.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$57.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.37
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
OP
|
$40.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1750473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$34.17 |
| Rate for Payer: Adventist Health Commercial |
$8.04
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.66
|
| Rate for Payer: Dignity Health Senior |
$16.20
|
| Rate for Payer: Dignity Health Senior |
$28.56
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$34.17
|
| Rate for Payer: Dignity Health Senior |
$17.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.56
|
| Rate for Payer: Heritage Provider Network Senior |
$15.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8.82
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$18.61
|
| Rate for Payer: Heritage Provider Network Senior |
$9.62
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$30.15
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Senior |
$28.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
| Rate for Payer: Vantage Medical Group Senior |
$34.17
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16.20
|
|
|
CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION [9491]
|
Facility
IP
|
$20.78
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1750473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$15.58 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Adventist Health Commercial |
$3.81
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$8.04
|
| Rate for Payer: Adventist Health Commercial |
$6.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cash Price |
$18.09
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.22
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$12.90
|
| Rate for Payer: Heritage Provider Network Senior |
$14.07
|
| Rate for Payer: Heritage Provider Network Senior |
$22.75
|
| Rate for Payer: Heritage Provider Network Senior |
$27.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$30.15
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.02
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
OP
|
$2.64
|
|
|
Service Code
|
NDC 55390-311-10
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.55
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.24
|
| Rate for Payer: Dignity Health Senior |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.24
|
| Rate for Payer: Vantage Medical Group Senior |
$2.24
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
OP
|
$1.83
|
|
|
Service Code
|
NDC 0409-7332-01
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.56
|
| Rate for Payer: Dignity Health Senior |
$1.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1.56
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
IP
|
$2.64
|
|
|
Service Code
|
NDC 55390-311-10
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Adventist Health Commercial |
$0.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.81
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.88
|
|
|
CEFTRIAXONE 1 GRAM INJECTION (IM) [4080782]
|
Facility
IP
|
$1.83
|
|
|
Service Code
|
NDC 0409-7332-01
|
| Hospital Charge Code |
ERX4080782
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.26
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.61
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
OP
|
$4.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$29.37 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: Dignity Health Senior |
$1.07
|
| Rate for Payer: Dignity Health Senior |
$3.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1.94
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.57
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$3.57
|
|
|
CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (1000 MG/10 ML IVPB) [9487]
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1720449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.87
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2.84
|
| Rate for Payer: Heritage Provider Network Senior |
$0.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.40
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
IP
|
$0.91
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.83
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
|
|
CEFTRIAXONE 250 MG INJECTION (IM) [4080777]
|
Facility
OP
|
$2.23
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$29.37 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Adventist Health Commercial |
$0.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Senior |
$0.77
|
| Rate for Payer: Dignity Health Senior |
$1.37
|
| Rate for Payer: Dignity Health Senior |
$1.90
|
| Rate for Payer: Dignity Health Senior |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.03
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1.25
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
IP
|
$2.23
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1780028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1.14
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
|
|
CEFTRIAXONE 250 MG SOLUTION FOR INJECTION [9489]
|
Facility
OP
|
$0.91
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
1780028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$29.37 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.90
|
| Rate for Payer: Dignity Health Senior |
$1.43
|
| Rate for Payer: Dignity Health Senior |
$1.90
|
| Rate for Payer: Dignity Health Senior |
$1.73
|
| Rate for Payer: Dignity Health Senior |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.78
|
| Rate for Payer: Heritage Provider Network Senior |
$0.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1.03
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.73
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$1.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1.90
|
|
|
CEFTRIAXONE 2 GRAM INJECTION (IM) [4080783]
|
Facility
OP
|
$3.47
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$29.37 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.95
|
| Rate for Payer: Dignity Health Senior |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2.95
|
|
|
CEFTRIAXONE 2 GRAM INJECTION (IM) [4080783]
|
Facility
IP
|
$3.47
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX4080783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.38
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.16
|
|
|
CEFTRIAXONE 2 GRAM INTRAVENOUS SOLUTION [27309]
|
Facility
OP
|
$9.57
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
ERX27309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$29.37 |
| Rate for Payer: Adventist Health Commercial |
$1.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.39
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cash Price |
$4.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.13
|
| Rate for Payer: Dignity Health Senior |
$8.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4.43
|
| Rate for Payer: IEHP Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.13
|
| Rate for Payer: Vantage Medical Group Senior |
$8.13
|
|
