|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
OP
|
$218.70
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.28 |
| Max. Negotiated Rate |
$174.96 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$131.22
|
| Rate for Payer: Aetna of CA Government/Medicare |
$131.22
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$174.96
|
| Rate for Payer: Health Smart Auto/Commercial |
$131.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$131.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.28
|
| Rate for Payer: Multiplan Commercial |
$164.03
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
OP
|
$258.61
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.24 |
| Max. Negotiated Rate |
$206.89 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$155.17
|
| Rate for Payer: Aetna of CA Government/Medicare |
$155.17
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$206.89
|
| Rate for Payer: Health Smart Auto/Commercial |
$155.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$155.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.24
|
| Rate for Payer: Multiplan Commercial |
$193.96
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
IP
|
$258.61
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.24 |
| Max. Negotiated Rate |
$206.89 |
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$206.89
|
| Rate for Payer: Health Smart Auto/Commercial |
$155.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.24
|
| Rate for Payer: Multiplan Commercial |
$193.96
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$22.08
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$17.29
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$100.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$48.00
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$19.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.97
|
| Rate for Payer: Health Smart Auto/Commercial |
$75.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$16.56
|
| Rate for Payer: Health Smart Auto/Commercial |
$36.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$126.13
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.37 |
| Max. Negotiated Rate |
$100.90 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$75.68
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$16.56
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.40
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$12.97
|
| Rate for Payer: Aetna of CA Government/Medicare |
$12.97
|
| Rate for Payer: Aetna of CA Government/Medicare |
$16.56
|
| Rate for Payer: Aetna of CA Government/Medicare |
$36.00
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$75.68
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$19.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$48.00
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$100.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$17.29
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$22.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Health Smart Auto/Commercial |
$75.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$12.97
|
| Rate for Payer: Health Smart Auto/Commercial |
$16.56
|
| Rate for Payer: Health Smart Auto/Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$12.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$75.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$36.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$14.40
|
| Rate for Payer: Aetna of CA Government/Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$19.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$19.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.65
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.65
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.87
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.87
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$8.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.12
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$8.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$8.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$4.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$4.10
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$5.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$6.12
|
| Rate for Payer: Aetna of CA Government/Medicare |
$6.12
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$8.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.17
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.17
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$4.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$4.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.29
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.29
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$7.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$7.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.29
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.29
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$7.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$7.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$4.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.17
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.17
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$4.22
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
IP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-23
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$11.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
|
OP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-23
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$8.68
|
| Rate for Payer: Aetna of CA Government/Medicare |
$8.68
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$11.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
|
