|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 5976221987
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 0781808926
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.36
|
| Rate for Payer: TriValley Medical Group Senior |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 0781808926
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.59
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 6586264130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 6586264130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 5011178751
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1.83
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$53.26 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California Commercial |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$4.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.98
|
| Rate for Payer: TriValley Medical Group Senior |
$2.98
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Multiplan Commercial |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.99
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 6586264230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.95
|
| Rate for Payer: Heritage Provider Network Senior |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1.30
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 6818086206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.37
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 6586264230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.99
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.15
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 6818086206
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.31
|
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.85
|
| Rate for Payer: TriValley Medical Group Senior |
$0.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.80
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 6809479930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.57
|
| Rate for Payer: Heritage Provider Network Senior |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 0069307030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.03
|
| Rate for Payer: Vantage Medical Group Senior |
$3.03
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 0069307030
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.30
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.68
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 6809479930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.41
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.52
|
| Rate for Payer: Heritage Provider Network Senior |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.59
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
NDC 6818086306
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Adventist Health Commercial |
$1.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.37
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.70
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
|
IP
|
$5.53
|
|
|
Service Code
|
NDC 6818086306
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Adventist Health Commercial |
$1.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.56
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
OP
|
$40.79
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Adventist Health Commercial |
$8.16
|
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.67
|
| 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 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 Medi-Cal |
$22.43
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| 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 |
$19.48
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$16.05
|
| 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: Cigna of CA HMO/PPO |
$18.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| 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 |
$34.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.71
|
| 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 |
$26.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.00
|
| Rate for Payer: Heritage Provider Network Senior |
$18.89
|
| Rate for Payer: Heritage Provider Network Senior |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$20.05
|
| Rate for Payer: Heritage Provider Network Senior |
$14.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| 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 |
$8.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.31
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$30.59
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$22.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.32
|
| Rate for Payer: TriValley Medical Group Senior |
$16.32
|
| Rate for Payer: TriValley Medical Group Senior |
$12.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| 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 |
$14.74
|
| 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: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.67
|
| 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 |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.70
|
| Rate for Payer: Vantage Medical Group Senior |
$34.67
|
| Rate for Payer: Vantage Medical Group Senior |
$30.32
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.70
|
|
|
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 |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.89
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cash Price |
$19.48
|
| 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: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.33
|
| 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 Commercial |
$18.89
|
| Rate for Payer: Heritage Provider Network Senior |
$18.89
|
| 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 |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.38
|
| 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 |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$22.68
|
| Rate for Payer: Multiplan Commercial |
$30.59
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.89
|
| 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 |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
|
|
AZTREONAM 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
IP
|
$80.34
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.20
|
| Rate for Payer: Cash Price |
$36.15
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$30.89
|
| 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: EPIC Health Plan Commercial |
$37.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.52
|
| 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 Foundation Hospitals Medi-Cal |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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: 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 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
OP
|
$68.64
|
|
|
Service Code
|
HCPCS J0457
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$58.34 |
| Rate for Payer: Adventist Health Commercial |
$13.73
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$16.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.29
|
| 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 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 |
$51.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.23
|
| 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 |
$32.10
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$36.15
|
| Rate for Payer: Cash Price |
$36.15
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.96
|
| 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 |
$60.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.34
|
| 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 |
$33.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.20
|
| 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 Foundation Hospitals Commercial |
$38.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$48.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$53.51
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: Multiplan Commercial |
$51.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.14
|
| Rate for Payer: TriValley Medical Group Senior |
$32.14
|
| Rate for Payer: TriValley Medical Group Senior |
$28.54
|
| Rate for Payer: TriValley Medical Group Senior |
$27.46
|
| 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 All Other HMO/non HMO |
$25.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.29
|
| 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 Medi-Cal |
$68.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.64
|
| 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-AVIBACTAM 2 GRAM INTRAVENOUS SOLUTION [245951]
|
Facility
|
OP
|
$412.02
|
|
|
Service Code
|
HCPCS J0458
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$309.01 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.93
|
| Rate for Payer: Blue Shield of California Commercial |
$251.33
|
| Rate for Payer: Blue Shield of California EPN |
$201.07
|
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.77
|
| Rate for Payer: Heritage Provider Network Senior |
$190.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$196.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$309.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$164.81
|
| Rate for Payer: TriValley Medical Group Senior |
$164.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$148.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$136.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1.77
|
|
|
AZTREONAM-AVIBACTAM 2 GRAM INTRAVENOUS SOLUTION [245951]
|
Facility
|
IP
|
$412.02
|
|
|
Service Code
|
HCPCS J0458
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.58 |
| Max. Negotiated Rate |
$309.01 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$265.34
|
| Rate for Payer: Cash Price |
$185.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.77
|
| Rate for Payer: Heritage Provider Network Senior |
$190.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Multiplan Commercial |
$309.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$148.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$136.42
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
OP
|
$191.98
|
|
|
Service Code
|
NDC 6195809011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$163.18 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.03
|
| Rate for Payer: Blue Shield of California Commercial |
$117.11
|
| Rate for Payer: Blue Shield of California EPN |
$93.69
|
| Rate for Payer: Cash Price |
$86.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.84
|
| Rate for Payer: Heritage Provider Network Senior |
$118.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.39
|
| Rate for Payer: Multiplan Commercial |
$143.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.79
|
| Rate for Payer: TriValley Medical Group Senior |
$76.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.18
|
| Rate for Payer: Vantage Medical Group Senior |
$163.18
|
|
