|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 60687-282-11
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.43
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
IP
|
$2.53
|
|
|
Service Code
|
NDC 51224-022-30
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.74
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1.71
|
| 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
|
|
|
AZITHROMYCIN 250 MG TABLET [20943]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 65862-641-30
|
| Hospital Charge Code |
1711545
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Senior |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Senior |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
1753436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$46.96 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA 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 |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.23
|
| Rate for Payer: Alpha Care 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 |
$2.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$3.35
|
| 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 |
$3.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.79
|
| 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 |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| 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: 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 |
$1.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.41
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.98
|
| Rate for Payer: TriValley Medical Group Senior |
$2.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2.98
|
| Rate for Payer: TriValley Medical Group Senior |
$2.40
|
| 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+ |
$2.49
|
| 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 |
$4.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION [21063]
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
CPT J0456
|
| Hospital Charge Code |
1753436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.87
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$3.82
|
| Rate for Payer: Heritage Provider Network Senior |
$5.04
|
| 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: 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 |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.06
|
| 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 Navigate/Select/Select+ |
$2.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.00
|
|
|
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
|
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
|
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: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care 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: TriValley Medical Group Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Senior |
$1.76
|
| 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
|
$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: Alpha Care Medical Group Commercial/Exchange |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.15
|
| Rate for Payer: Alpha Care 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: TriValley Medical Group Commercial |
$2.29
|
| Rate for Payer: TriValley Medical Group Senior |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4.87
|
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$3.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.42
|
| Rate for Payer: Alpha Care 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: TriValley Medical Group Commercial |
$1.76
|
| Rate for Payer: TriValley Medical Group Senior |
$1.76
|
| 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
|
$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 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
|
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care 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: TriValley Medical Group Commercial |
$2.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2.55
|
| 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: Alpha Care Medical Group Commercial/Exchange |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.15
|
| Rate for Payer: 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: TriValley Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Senior |
$2.21
|
| 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
|
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: Alpha Care Medical Group Commercial/Exchange |
$5.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.50
|
| Rate for Payer: Alpha Care 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: TriValley Medical Group Commercial |
$2.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2.55
|
| 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
|
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
|
|
|
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 |
$29.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.51
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$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 |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| 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 All Other HMO/non HMO |
$14.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.23
|
|
|
AZTREONAM 1 GRAM SOLUTION FOR INJECTION [9185]
|
Facility
|
OP
|
$43.30
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1721161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$32.48 |
| Rate for Payer: Adventist Health Commercial |
$8.66
|
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Adventist Health Commercial |
$7.13
|
| 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 |
$27.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$26.89
|
| 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 EPN |
$25.42
|
| Rate for Payer: Blue Shield of California EPN |
$23.25
|
| Rate for Payer: Blue Shield of California EPN |
$20.94
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| 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: 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 |
$27.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| 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 |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$16.52
|
| Rate for Payer: Heritage Provider Network Senior |
$18.33
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (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 |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.17
|
| 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 |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$15.84
|
| Rate for Payer: TriValley Medical Group Senior |
$17.32
|
| 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+ |
$11.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.47
|
| 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 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
OP
|
$87.97
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1753314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| 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 |
$60.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.79
|
| Rate for Payer: Blue Shield of California Commercial |
$54.63
|
| Rate for Payer: Blue Shield of California Commercial |
$44.30
|
| Rate for Payer: Blue Shield of California Commercial |
$48.44
|
| Rate for Payer: Blue Shield of California EPN |
$51.64
|
| Rate for Payer: Blue Shield of California EPN |
$45.79
|
| Rate for Payer: Blue Shield of California EPN |
$41.88
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| 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 |
$56.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.92
|
| 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 |
$40.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.03
|
| Rate for Payer: Heritage Provider Network Senior |
$33.03
|
| Rate for Payer: Heritage Provider Network Senior |
$36.11
|
| Rate for Payer: Heritage Provider Network Senior |
$40.73
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (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 |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| 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 |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| 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 |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.54
|
| Rate for Payer: TriValley Medical Group Senior |
$28.54
|
| Rate for Payer: TriValley Medical Group Senior |
$31.20
|
| Rate for Payer: TriValley Medical Group Senior |
$35.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.39
|
| 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 2 GRAM SOLUTION FOR INJECTION [9186]
|
Facility
|
IP
|
$87.97
|
|
|
Service Code
|
CPT J0457
|
| Hospital Charge Code |
1753314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$17.59
|
| Rate for Payer: Adventist Health Commercial |
$14.27
|
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.01
|
| Rate for Payer: Cash Price |
$39.59
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$48.30
|
| Rate for Payer: Heritage Provider Network Senior |
$59.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$65.98
|
| Rate for Payer: Multiplan Commercial |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.06
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
OP
|
$148.49
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
NDG100393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Adventist Health Commercial |
$29.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Blue Shield of California Commercial |
$92.21
|
| Rate for Payer: Blue Shield of California EPN |
$87.16
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.22
|
| Rate for Payer: Dignity Health Senior |
$126.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.92
|
| Rate for Payer: Heritage Provider Network Senior |
$91.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.12
|
| Rate for Payer: Multiplan Commercial |
$111.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$59.40
|
| Rate for Payer: TriValley Medical Group Senior |
$59.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.22
|
| Rate for Payer: Vantage Medical Group Senior |
$126.22
|
|
|
AZTREONAM LYSINE 75 MG/ML SOLUTION FOR NEBULIZATION [100393]
|
Facility
|
IP
|
$148.49
|
|
|
Service Code
|
NDC 61958-0901-1
|
| Hospital Charge Code |
NDG100393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$111.37 |
| Rate for Payer: Adventist Health Commercial |
$29.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.01
|
| Rate for Payer: Cash Price |
$66.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.53
|
| Rate for Payer: Heritage Provider Network Senior |
$100.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.12
|
| Rate for Payer: Multiplan Commercial |
$111.37
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
|
IP
|
$37.06
|
|
|
Service Code
|
NDC 0574-4022-35
|
| Hospital Charge Code |
1740071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$27.80 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.46
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.09
|
| Rate for Payer: Heritage Provider Network Senior |
$25.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.26
|
| Rate for Payer: Multiplan Commercial |
$27.80
|
|
|
BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]
|
Facility
|
OP
|
$37.06
|
|
|
Service Code
|
NDC 0574-4022-35
|
| Hospital Charge Code |
1740071
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.01
|
| Rate for Payer: Blue Shield of California EPN |
$21.75
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.50
|
| Rate for Payer: Dignity Health Senior |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.94
|
| Rate for Payer: Heritage Provider Network Senior |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.26
|
| Rate for Payer: Multiplan Commercial |
$27.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.82
|
| Rate for Payer: TriValley Medical Group Senior |
$14.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.50
|
| Rate for Payer: Vantage Medical Group Senior |
$31.50
|
|
