|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
OP
|
$35.67
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$8.16
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$19.62
|
| Rate for Payer: Cash Price |
$19.62
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.67
|
| Rate for Payer: Dignity Health Senior |
$34.67
|
| Rate for Payer: Dignity Health Senior |
$36.80
|
| Rate for Payer: Dignity Health Senior |
$30.32
|
| Rate for Payer: Dignity Health Senior |
$25.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.05
|
| Rate for Payer: Heritage Provider Network Senior |
$20.05
|
| Rate for Payer: Heritage Provider Network Senior |
$14.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$18.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.31
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$30.59
|
| Rate for Payer: Multiplan Commercial |
$22.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.32
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$12.10
|
| Rate for Payer: TriValley Medical Group Senior |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.70
|
| Rate for Payer: Vantage Medical Group Senior |
$30.32
|
| Rate for Payer: Vantage Medical Group Senior |
$34.67
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
IP
|
$40.79
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Adventist Health Commercial |
$8.16
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$19.62
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.00
|
| Rate for Payer: Heritage Provider Network Senior |
$20.05
|
| Rate for Payer: Heritage Provider Network Senior |
$14.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$18.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$22.68
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$30.59
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.01
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
OP
|
$71.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$60.64 |
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$37.75
|
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Cash Price |
$39.24
|
| Rate for Payer: Cash Price |
$39.24
|
| Rate for Payer: Cash Price |
$37.75
|
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.29
|
| Rate for Payer: Dignity Health Senior |
$68.29
|
| Rate for Payer: Dignity Health Senior |
$58.34
|
| Rate for Payer: Dignity Health Senior |
$60.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.03
|
| Rate for Payer: Heritage Provider Network Senior |
$37.20
|
| Rate for Payer: Heritage Provider Network Senior |
$31.78
|
| Rate for Payer: Heritage Provider Network Senior |
$33.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.05
|
| Rate for Payer: Multiplan Commercial |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$53.51
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.46
|
| Rate for Payer: TriValley Medical Group Senior |
$27.46
|
| Rate for Payer: TriValley Medical Group Senior |
$32.14
|
| Rate for Payer: TriValley Medical Group Senior |
$28.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.29
|
| Rate for Payer: Vantage Medical Group Senior |
$58.34
|
| Rate for Payer: Vantage Medical Group Senior |
$68.29
|
| Rate for Payer: Vantage Medical Group Senior |
$60.64
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
IP
|
$71.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$53.51 |
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Cash Price |
$39.24
|
| Rate for Payer: Cash Price |
$44.19
|
| Rate for Payer: Cash Price |
$37.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.03
|
| Rate for Payer: Heritage Provider Network Senior |
$33.03
|
| Rate for Payer: Heritage Provider Network Senior |
$31.78
|
| Rate for Payer: Heritage Provider Network Senior |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: Multiplan Commercial |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$53.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.62
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
IP
|
$181.28
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$135.96 |
| Rate for Payer: Adventist Health Commercial |
$36.26
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.73
|
| Rate for Payer: Heritage Provider Network Senior |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.32
|
| Rate for Payer: Multiplan Commercial |
$135.96
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
OP
|
$181.28
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$154.09 |
| Rate for Payer: Adventist Health Commercial |
$36.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.96
|
| Rate for Payer: Blue Shield of California Commercial |
$110.58
|
| Rate for Payer: Blue Shield of California EPN |
$88.46
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.09
|
| Rate for Payer: Dignity Health Senior |
$154.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.21
|
| Rate for Payer: Heritage Provider Network Senior |
$112.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.90
|
| Rate for Payer: Multiplan Commercial |
$135.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$72.51
|
| Rate for Payer: TriValley Medical Group Senior |
$72.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$90.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.09
|
| Rate for Payer: Vantage Medical Group Senior |
$154.09
|
|
|
B2000ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5386
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2001ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5387
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B200YZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5388
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2010ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5389
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2011ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5390
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B201YZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5391
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2020ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5392
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2021ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5393
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B202YZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5394
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2030ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5395
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2031ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5396
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B203YZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5397
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2040ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5398
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2041ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5399
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B204YZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5400
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2050ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5401
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2051ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5402
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B205YZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5403
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
B2060ZZ
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5404
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$4,982.00 |
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
