|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
OP
|
$6.70
|
|
|
Service Code
|
NDC 43598-220-28
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California EPN |
$3.93
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.70
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
IP
|
$8.04
|
|
|
Service Code
|
NDC 43598-020-28
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.52
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
OP
|
$7.37
|
|
|
Service Code
|
NDC 0781-1943-39
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.33
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: Dignity Health Senior |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
OP
|
$8.04
|
|
|
Service Code
|
NDC 43598-020-28
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$4.72
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Senior |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
IP
|
$7.37
|
|
|
Service Code
|
NDC 0781-1943-82
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.06
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
|
|
AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR [33862]
|
Facility
OP
|
$7.37
|
|
|
Service Code
|
NDC 0781-1943-82
|
| Hospital Charge Code |
ERX33862
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Adventist Health Commercial |
$1.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$4.33
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.26
|
| Rate for Payer: Dignity Health Senior |
$6.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$5.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.26
|
| Rate for Payer: Vantage Medical Group Senior |
$6.26
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
IP
|
$52.44
|
|
|
Service Code
|
CPT J0285
|
| Hospital Charge Code |
1757256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Adventist Health Commercial |
$10.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.03
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.50
|
| Rate for Payer: Heritage Provider Network Senior |
$35.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.11
|
| Rate for Payer: Multiplan Commercial |
$39.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.52
|
|
|
AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION [464]
|
Facility
OP
|
$52.44
|
|
|
Service Code
|
CPT J0285
|
| Hospital Charge Code |
1757256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$44.57 |
| Rate for Payer: Adventist Health Commercial |
$10.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.21
|
| Rate for Payer: Blue Shield of California Commercial |
$44.57
|
| Rate for Payer: Blue Shield of California EPN |
$44.57
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cash Price |
$23.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.57
|
| Rate for Payer: Dignity Health Senior |
$44.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: IEHP Medi-Cal |
$21.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.11
|
| Rate for Payer: Multiplan Commercial |
$39.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.57
|
| Rate for Payer: Vantage Medical Group Senior |
$44.57
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
IP
|
$360.05
|
|
|
Service Code
|
NDC 0469-3051-30
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$270.04 |
| Rate for Payer: Adventist Health Commercial |
$72.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.35
|
| Rate for Payer: Cash Price |
$162.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Senior |
$243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.01
|
| Rate for Payer: Multiplan Commercial |
$270.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$131.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.29
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
OP
|
$360.05
|
|
|
Service Code
|
NDC 0469-3051-30
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Adventist Health Commercial |
$72.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$306.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$198.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$270.04
|
| Rate for Payer: Blue Shield of California Commercial |
$223.59
|
| Rate for Payer: Blue Shield of California EPN |
$211.35
|
| Rate for Payer: Cash Price |
$162.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.04
|
| Rate for Payer: Dignity Health Senior |
$306.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.70
|
| Rate for Payer: Heritage Provider Network Senior |
$166.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.01
|
| Rate for Payer: Multiplan Commercial |
$270.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$131.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.04
|
| Rate for Payer: Vantage Medical Group Senior |
$306.04
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
IP
|
$305.70
|
|
|
Service Code
|
NDC 55150-365-01
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$229.28 |
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.02
|
| Rate for Payer: Cash Price |
$137.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.96
|
| Rate for Payer: Heritage Provider Network Senior |
$206.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.42
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$111.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$102.13
|
|
|
AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION [21900]
|
Facility
OP
|
$305.70
|
|
|
Service Code
|
NDC 55150-365-01
|
| Hospital Charge Code |
1757065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$259.84 |
| Rate for Payer: Adventist Health Commercial |
$61.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.28
|
| Rate for Payer: Blue Shield of California Commercial |
$189.84
|
| Rate for Payer: Blue Shield of California EPN |
$179.45
|
| Rate for Payer: Cash Price |
$137.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.84
|
| Rate for Payer: Dignity Health Senior |
$259.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.54
|
| Rate for Payer: Heritage Provider Network Senior |
$141.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.42
|
| Rate for Payer: Multiplan Commercial |
$229.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$111.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$102.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.84
|
| Rate for Payer: Vantage Medical Group Senior |
$259.84
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
IP
|
$4.56
|
|
|
Service Code
|
NDC 9994-0802-41
|
| Hospital Charge Code |
1715157
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.13
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
|
|
AMPHOTERICIN ORAL SUSPENSION COMPOUND 5 MG/ML [4080241]
|
Facility
OP
|
$4.56
|
|
|
Service Code
|
NDC 9994-0802-41
|
| Hospital Charge Code |
1715157
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Adventist Health Commercial |
$0.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2.83
|
| Rate for Payer: Blue Shield of California EPN |
$2.68
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.88
|
| Rate for Payer: Dignity Health Senior |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3.88
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1752200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$56.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.69
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.07
|
|
|
AMPICILLIN 10 GRAM SOLUTION FOR INJECTION [470]
|
Facility
OP
|
$82.77
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1752200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$70.35 |
| Rate for Payer: Adventist Health Commercial |
$16.55
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$37.25
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.35
|
| Rate for Payer: Dignity Health Senior |
$70.35
|
| Rate for Payer: Dignity Health Senior |
$66.30
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$38.32
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.69
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$62.08
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.35
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
OP
|
$6.63
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.64
|
| Rate for Payer: Dignity Health Senior |
$5.64
|
| Rate for Payer: Dignity Health Senior |
$4.94
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2.69
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$4.94
|
|
|
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION [469]
|
Facility
IP
|
$6.63
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Adventist Health Commercial |
$1.33
|
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.93
|
| Rate for Payer: Heritage Provider Network Senior |
$3.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4.49
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.41
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]
|
Facility
IP
|
$2.22
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
|
|
AMPICILLIN 250 MG SOLUTION FOR INJECTION [473]
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.88
|
| Rate for Payer: Dignity Health Senior |
$1.88
|
| Rate for Payer: Dignity Health Senior |
$1.89
|
| Rate for Payer: Dignity Health Senior |
$2.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1.03
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
OP
|
$8.53
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Senior |
$13.67
|
| Rate for Payer: Dignity Health Senior |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$7.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3.95
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$13.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION [472]
|
Facility
IP
|
$8.53
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Adventist Health Commercial |
$3.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.05
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.85
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
IP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
1710493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.42
|
| Rate for Payer: Heritage Provider Network Senior |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
|
|
AMPICILLIN 500 MG CAPSULE [466]
|
Facility
OP
|
$0.62
|
|
|
Service Code
|
NDC 0781-2145-01
|
| Hospital Charge Code |
1710493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.39
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.53
|
| Rate for Payer: Dignity Health Senior |
$0.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Senior |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.53
|
| Rate for Payer: Vantage Medical Group Senior |
$0.53
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION [474]
|
Facility
OP
|
$2.84
|
|
|
Service Code
|
CPT J0290
|
| Hospital Charge Code |
1720396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Dignity Health Senior |
$2.87
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.82
|
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Adventist Health Commercial |
$0.68
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: IEHP Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2.41
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$2.87
|
|
