|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK PER PHARMACY [40892895]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK PER PHARMACY [40892895]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.12
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$6.51
|
|
|
Service Code
|
NDC 0409-6534-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$3.91
|
| Rate for Payer: Aetna of CA Government/Medicare |
$3.91
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.88
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
NDC 63323-221-10
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
IP
|
$6.51
|
|
|
Service Code
|
NDC 0409-6534-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Health Smart Auto/Commercial |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$4.88
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
NDC 0409-4332-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.87
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.87
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.34
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
NDC 63323-221-10
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.04
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
NDC 0409-4332-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.83
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.34
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.04
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.87
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.87
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.79
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.87
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.87
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.24
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.87
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.24
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Health Smart Auto/Commercial |
$5.79
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.04
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$5.87
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.04
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.87
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.16
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$5.79
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.87
|
| Rate for Payer: Aetna of CA Government/Medicare |
$5.79
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.34
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.30
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$7.24
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.47 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$57.24
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$35.99
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$17.54
|
| Rate for Payer: Aetna of CA Government/Medicare |
$57.24
|
| Rate for Payer: Aetna of CA Government/Medicare |
$17.54
|
| Rate for Payer: Aetna of CA Government/Medicare |
$35.99
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$35.99
|
| Rate for Payer: Health Smart Auto/Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$35.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$17.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$57.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$71.55
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$44.99
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.93
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
IP
|
$59.99
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$47.99 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$57.24
|
| Rate for Payer: Health Smart Auto/Commercial |
$17.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$44.99
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$21.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$71.55
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.16
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.16
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.88
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.70
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.08
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Cigna of CA HMO/PPO |
$9.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.42
|
| Rate for Payer: Health Smart Auto/Commercial |
$4.81
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$6.02
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$8.85
|
|
