|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.02
|
| Rate for Payer: Heritage Provider Network Senior |
$250.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$195.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.79
|
|
|
CEFEPIME 100 GRAM INTRAVENOUS SOLUTION [223402]
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$288.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Senior |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.02
|
| Rate for Payer: Heritage Provider Network Senior |
$250.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Senior |
$216.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$195.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
CEFEPIME 1 GRAM IM INJECTION (PEDS) [40816369]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.26
|
|
|
CEFEPIME 1 GRAM IM INJECTION (PEDS) [40816369]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Senior |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Senior |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]
|
Facility
|
OP
|
$6.06
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.15
|
| Rate for Payer: Dignity Health Senior |
$5.14
|
| Rate for Payer: Dignity Health Senior |
$5.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.24
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.42
|
| Rate for Payer: TriValley Medical Group Senior |
$2.42
|
| Rate for Payer: TriValley Medical Group Senior |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5.14
|
| Rate for Payer: Vantage Medical Group Senior |
$5.15
|
|
|
CEFEPIME 1 GRAM SOLUTION FOR INJECTION [16369]
|
Facility
|
IP
|
$6.05
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]
|
Facility
|
IP
|
$12.06
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.89
|
|
|
CEFEPIME 2 GRAM SOLUTION FOR INJECTION (100 MG/ML IVPB) [16371]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.25
|
| Rate for Payer: Dignity Health Senior |
$10.25
|
| Rate for Payer: Dignity Health Senior |
$11.06
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Senior |
$6.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.11
|
| Rate for Payer: Multiplan Commercial |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Multiplan Commercial |
$8.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$5.20
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4.70
|
| Rate for Payer: TriValley Medical Group Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.06
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFEPIME (MAXIPIME) 1G/10ML FROZEN SYRINGE [4081917]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
|
|
CEFEPIME (MAXIPIME) 2G/20ML FROZEN SYRINGE [4081790]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.60
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.50
|
| Rate for Payer: Dignity Health Senior |
$0.46
|
| Rate for Payer: Dignity Health Senior |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.25
|
| Rate for Payer: Heritage Provider Network Senior |
$0.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.22
|
| Rate for Payer: TriValley Medical Group Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.50
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
|
OP
|
$279.41
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$209.56 |
| Rate for Payer: Adventist Health Commercial |
$55.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.24
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.64
|
| Rate for Payer: Dignity Health Senior |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$209.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.76
|
| Rate for Payer: TriValley Medical Group Senior |
$111.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2.64
|
|
|
CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION [227170]
|
Facility
|
IP
|
$279.41
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.57 |
| Max. Negotiated Rate |
$209.56 |
| Rate for Payer: Adventist Health Commercial |
$55.88
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$209.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.51
|
|
|
CEFIDEROCOL (FETROJA) 1 GM/100 ML IVPB [40820782]
|
Facility
|
IP
|
$279.41
|
|
|
Service Code
|
HCPCS J0699
|
| Min. Negotiated Rate |
$50.57 |
| Max. Negotiated Rate |
$209.56 |
| Rate for Payer: Adventist Health Commercial |
$55.88
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.16
|
| Rate for Payer: Heritage Provider Network Senior |
$189.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$209.56
|
|
|
CEFIDEROCOL (FETROJA) 1 GM/100 ML IVPB [40820782]
|
Facility
|
OP
|
$279.41
|
|
|
Service Code
|
HCPCS J0699
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$209.56 |
| Rate for Payer: Adventist Health Commercial |
$55.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$170.44
|
| Rate for Payer: Blue Shield of California EPN |
$136.35
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.64
|
| Rate for Payer: Dignity Health Senior |
$2.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.95
|
| Rate for Payer: Heritage Provider Network Senior |
$172.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$209.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$139.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2.64
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California EPN |
$3.91
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
CEFIXIME 200 MG/5 ML ORAL SUSPENSION [81816]
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 65862-752-75
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.43
|
| Rate for Payer: Heritage Provider Network Senior |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
|
OP
|
$107.99
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$91.79 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Cash Price |
$59.39
|
| Rate for Payer: Cash Price |
$59.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.79
|
| Rate for Payer: Dignity Health Senior |
$91.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.00
|
| Rate for Payer: Heritage Provider Network Senior |
$50.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.79
|
| Rate for Payer: Vantage Medical Group Senior |
$91.79
|
|
|
CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION (100 MG/ML IVPB) [9462]
|
Facility
|
IP
|
$107.99
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$80.99 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$59.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.00
|
| Rate for Payer: Heritage Provider Network Senior |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$80.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.76
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$10.10
|
| Rate for Payer: Dignity Health Senior |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$3.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$10.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
|
|
CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION [9461]
|
Facility
|
IP
|
$7.20
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.50
|
| 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 |
$5.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.29
|
| Rate for Payer: Multiplan Commercial |
$8.91
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$18.11 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Senior |
$8.16
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Senior |
$4.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3.84
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$14.24
|
|
|
CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION [9463]
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$9.21
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Heritage Provider Network Senior |
$7.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$12.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.55
|
|
|
CEFPODOXIME 200 MG TABLET [9469]
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 65862-096-20
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Adventist Health Commercial |
$0.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.81
|
| Rate for Payer: Dignity Health Senior |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.79
|
| Rate for Payer: TriValley Medical Group Senior |
$1.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.81
|
| Rate for Payer: Vantage Medical Group Senior |
$3.81
|
|
