|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
OP
|
$1.87
|
|
|
Service Code
|
NDC 60687-282-65
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.10
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.59
|
| Rate for Payer: Dignity Health Senior |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.59
|
| Rate for Payer: Vantage Medical Group Senior |
$1.59
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
OP
|
$2.53
|
|
|
Service Code
|
NDC 51224-022-30
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.49
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.15
|
| Rate for Payer: Dignity Health Senior |
$2.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2.15
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
IP
|
$1.87
|
|
|
Service Code
|
NDC 60687-282-65
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.28
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.47
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
NDC 50111-787-51
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.06
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
OP
|
$2.55
|
|
|
Service Code
|
NDC 50111-787-10
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1.58
|
| Rate for Payer: Blue Shield of California EPN |
$1.50
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.17
|
| Rate for Payer: Dignity Health Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
OP
|
$2.60
|
|
|
Service Code
|
NDC 0781-8089-26
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.53
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: Dignity Health Senior |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
IP
|
$2.60
|
|
|
Service Code
|
NDC 0781-8089-26
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.79
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$1.95
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
IP
|
$0.27
|
|
|
Service Code
|
NDC 59762-2198-7
|
| Hospital Charge Code |
1711545
|
|
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 |
$0.19
|
| 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 Permanente of CA 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
|
$0.27
|
|
|
Service Code
|
NDC 59762-2198-7
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.23
|
| Rate for Payer: Dignity Health Senior |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.17
|
| Rate for Payer: Heritage Provider Network Senior |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
IP
|
$5.64
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
1753436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.11
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.54
|
| 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 |
$3.42
|
| 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 |
$5.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.82
|
| Rate for Payer: Heritage Provider Network Senior |
$5.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| 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 |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| 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+ |
$1.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.49
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
OP
|
$5.64
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
1753436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$46.96 |
| 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 Gatekeeper |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4.95
|
| Rate for Payer: Blue Shield of California EPN |
$4.95
|
| Rate for Payer: Blue Shield of California EPN |
$4.95
|
| Rate for Payer: Blue Shield of California EPN |
$4.95
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| 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 Senior |
$6.32
|
| Rate for Payer: Dignity Health Senior |
$4.79
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: IEHP Medi-Cal |
$11.01
|
| Rate for Payer: IEHP Medi-Cal |
$11.01
|
| Rate for Payer: IEHP Medi-Cal |
$11.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-21
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.02
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-21
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Senior |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
OP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-11
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2.73
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.74
|
| Rate for Payer: Dignity Health Senior |
$3.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.74
|
| Rate for Payer: Vantage Medical Group Senior |
$3.74
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
IP
|
$4.40
|
|
|
Service Code
|
NDC 60687-271-11
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Adventist Health Commercial |
$0.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.02
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.30
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
IP
|
$5.73
|
|
|
Service Code
|
NDC 51224-122-30
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
|
|
AZITHROMYCIN 500 MG TABLET [17482]
|
Facility
OP
|
$5.73
|
|
|
Service Code
|
NDC 51224-122-30
|
| Hospital Charge Code |
1710984
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.36
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.87
|
| Rate for Payer: Dignity Health Senior |
$4.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4.87
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
IP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-25
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-25
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
IP
|
$5.53
|
|
|
Service Code
|
NDC 51224-222-30
|
| Hospital Charge Code |
1710985
|
|
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 |
$3.80
|
| 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 Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
OP
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-95
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.41 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.74
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.41
|
| Rate for Payer: Dignity Health Senior |
$5.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.41
|
| Rate for Payer: Vantage Medical Group Senior |
$5.41
|
|
|
AZITHROMYCIN 600 MG TABLET [17387]
|
Facility
OP
|
$5.53
|
|
|
Service Code
|
NDC 51224-222-30
|
| Hospital Charge Code |
1710985
|
|
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 Gatekeeper |
$2.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$3.25
|
| 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 Senior |
$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 Permanente of CA Commercial |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.15
|
| 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
|
$6.37
|
|
|
Service Code
|
NDC 60687-314-95
|
| Hospital Charge Code |
1710985
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Adventist Health Commercial |
$1.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.38
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$4.78
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
OP
|
$35.67
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$22.15
|
| Rate for Payer: Blue Shield of California Commercial |
$24.59
|
| Rate for Payer: Blue Shield of California Commercial |
$26.89
|
| Rate for Payer: Blue Shield of California EPN |
$20.94
|
| Rate for Payer: Blue Shield of California EPN |
$23.25
|
| Rate for Payer: Blue Shield of California EPN |
$25.42
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$17.82
|
| 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 |
$18.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Senior |
$2.79
|
| Rate for Payer: Dignity Health Senior |
$2.79
|
| Rate for Payer: Dignity Health Senior |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.05
|
| Rate for Payer: Heritage Provider Network Senior |
$18.33
|
| Rate for Payer: Heritage Provider Network Senior |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$20.05
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: IEHP Medi-Cal |
$10.92
|
| Rate for Payer: IEHP Medi-Cal |
$10.92
|
| Rate for Payer: IEHP Medi-Cal |
$10.92
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
IP
|
$43.30
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.75
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.81
|
| Rate for Payer: Heritage Provider Network Senior |
$26.81
|
| Rate for Payer: Heritage Provider Network Senior |
$24.15
|
| Rate for Payer: Heritage Provider Network Senior |
$29.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.23
|
|
