|
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 |
$0.04 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
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 |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
|
|
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 |
$2.35 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.83
|
| Rate for Payer: Blue Distinction Transplant |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$5.72
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Media |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$6.36
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
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 |
$1.56 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.88
|
| Rate for Payer: Blue Distinction Transplant |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.80
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$4.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.53
|
| Rate for Payer: Dignity Health Media |
$5.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.60
|
| Rate for Payer: Galaxy Health WC |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.21
|
| Rate for Payer: Networks By Design Commercial |
$4.23
|
| Rate for Payer: Prime Health Services Commercial |
$5.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.26
|
| Rate for Payer: United Healthcare All Other HMO |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.53
|
| Rate for Payer: Vantage Medical Group Senior |
$5.53
|
|
|
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 |
$2.02 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.00
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$5.46
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
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 |
$1.56 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.33
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$4.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.60
|
| Rate for Payer: Galaxy Health WC |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.21
|
| Rate for Payer: Networks By Design Commercial |
$4.23
|
| Rate for Payer: Prime Health Services Commercial |
$5.53
|
|
|
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 |
$2.02 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$5.46
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
|
|
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 |
$2.35 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$5.01
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$6.36
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Distinction Transplant |
$5.87
|
| Rate for Payer: Blue Distinction Transplant |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Media |
$8.32
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.61
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$5.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Distinction Transplant |
$5.87
|
| Rate for Payer: Blue Distinction Transplant |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Media |
$8.32
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.01
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.61
|
| Rate for Payer: United Healthcare All Other HMO |
$3.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.77
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
IP
|
$29.24
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Blue Shield of California Commercial |
$20.82
|
| Rate for Payer: Blue Shield of California Commercial |
$42.71
|
| Rate for Payer: Blue Shield of California Commercial |
$67.92
|
| Rate for Payer: Blue Shield of California EPN |
$30.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.84
|
| Rate for Payer: Blue Shield of California EPN |
$14.97
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.90
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$47.99
|
| Rate for Payer: Multiplan Commercial |
$76.32
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Prime Health Services Commercial |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Other HMO |
$22.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.18
|
| Rate for Payer: United Healthcare HMO Rider |
$34.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.48
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
OP
|
$29.24
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$57.24
|
| Rate for Payer: Blue Distinction Transplant |
$35.99
|
| Rate for Payer: Blue Distinction Transplant |
$17.54
|
| Rate for Payer: Blue Shield of California Commercial |
$44.21
|
| Rate for Payer: Blue Shield of California Commercial |
$21.55
|
| Rate for Payer: Blue Shield of California Commercial |
$70.31
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.09
|
| Rate for Payer: Dignity Health Media |
$50.99
|
| Rate for Payer: Dignity Health Media |
$24.85
|
| Rate for Payer: Dignity Health Media |
$81.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.93
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$47.99
|
| Rate for Payer: Multiplan Commercial |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.70
|
| Rate for Payer: United Healthcare All Other HMO |
$47.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$47.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
|
|
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 |
$0.86 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
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 |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$7.08
|
| Rate for Payer: Blue Distinction Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$8.26
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Media |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$5.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$10.03
|
|
|
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 |
$2.83 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.04
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO |
$4.35
|
| Rate for Payer: United Healthcare All Other HMO |
$2.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$2.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.65
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: Blue Distinction Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Media |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
OP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: Blue Distinction Transplant |
$139.54
|
| Rate for Payer: Blue Shield of California Commercial |
$171.40
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO |
$162.79
|
| Rate for Payer: Cigna of CA PPO |
$162.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.68
|
| Rate for Payer: Dignity Health Media |
$197.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.02
|
| Rate for Payer: Galaxy Health WC |
$197.68
|
| Rate for Payer: Global Benefits Group Commercial |
$139.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$174.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Multiplan Commercial |
$186.05
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Other HMO |
$116.28
|
| Rate for Payer: United Healthcare HMO Rider |
$116.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.68
|
| Rate for Payer: Vantage Medical Group Senior |
$197.68
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
IP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Blue Shield of California Commercial |
$165.58
|
| Rate for Payer: Blue Shield of California EPN |
$119.07
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO |
$162.79
|
| Rate for Payer: Cigna of CA PPO |
$162.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.02
|
| Rate for Payer: Galaxy Health WC |
$197.68
|
| Rate for Payer: Global Benefits Group Commercial |
$139.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Multiplan Commercial |
$186.05
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.81
|
| Rate for Payer: United Healthcare All Other HMO |
$85.77
|
| Rate for Payer: United Healthcare HMO Rider |
$83.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.74
|
|
|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 9994-0804-46
|
| Hospital Charge Code |
1715272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Distinction Transplant |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Media |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
