|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
|
IP
|
$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: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| 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: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| 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
|
|
|
VARENICLINE 0.5 MG TABLET [76444]
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
NDC 0069-0468-56
|
| Hospital Charge Code |
1712341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Blue Shield of California Commercial |
$6.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.00
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cigna of CA HMO |
$6.83
|
| Rate for Payer: Cigna of CA PPO |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.81
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
|
|
VARENICLINE 0.5 MG TABLET [76444]
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
NDC 0069-0468-56
|
| Hospital Charge Code |
1712341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Distinction Transplant |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$7.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.70
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cigna of CA HMO |
$6.83
|
| Rate for Payer: Cigna of CA PPO |
$6.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: Dignity Health Media |
$8.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$7.81
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4.88
|
| Rate for Payer: United Healthcare HMO Rider |
$4.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
OP
|
$191.09
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
1721059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$1,235.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,235.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.68
|
| Rate for Payer: Blue Distinction Transplant |
$114.65
|
| Rate for Payer: Blue Shield of California Commercial |
$140.83
|
| Rate for Payer: Blue Shield of California EPN |
$170.82
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cigna of CA HMO |
$133.76
|
| Rate for Payer: Cigna of CA PPO |
$133.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.43
|
| Rate for Payer: Dignity Health Media |
$162.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.44
|
| Rate for Payer: Galaxy Health WC |
$162.43
|
| Rate for Payer: Global Benefits Group Commercial |
$114.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$143.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.86
|
| Rate for Payer: Multiplan Commercial |
$152.87
|
| Rate for Payer: Networks By Design Commercial |
$95.54
|
| Rate for Payer: Prime Health Services Commercial |
$162.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.54
|
| Rate for Payer: United Healthcare All Other HMO |
$95.54
|
| Rate for Payer: United Healthcare HMO Rider |
$95.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.43
|
| Rate for Payer: Vantage Medical Group Senior |
$162.43
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
IP
|
$191.09
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
1721059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$162.43 |
| Rate for Payer: Blue Shield of California Commercial |
$136.06
|
| Rate for Payer: Blue Shield of California EPN |
$97.84
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cigna of CA HMO |
$133.76
|
| Rate for Payer: Cigna of CA PPO |
$133.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.44
|
| Rate for Payer: Galaxy Health WC |
$162.43
|
| Rate for Payer: Global Benefits Group Commercial |
$114.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.86
|
| Rate for Payer: Multiplan Commercial |
$152.87
|
| Rate for Payer: Networks By Design Commercial |
$95.54
|
| Rate for Payer: Prime Health Services Commercial |
$162.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.16
|
| Rate for Payer: United Healthcare All Other HMO |
$70.47
|
| Rate for Payer: United Healthcare HMO Rider |
$68.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.06
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-11
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$161.21 |
| Rate for Payer: Blue Shield of California Commercial |
$135.04
|
| Rate for Payer: Blue Shield of California EPN |
$97.11
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.52
|
| Rate for Payer: Multiplan Commercial |
$151.73
|
| Rate for Payer: Networks By Design Commercial |
$123.28
|
| Rate for Payer: Prime Health Services Commercial |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-10
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California EPN |
$49.77
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.33
|
| Rate for Payer: Multiplan Commercial |
$77.76
|
| Rate for Payer: Networks By Design Commercial |
$63.18
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-10
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.91
|
| Rate for Payer: Blue Distinction Transplant |
$58.32
|
| Rate for Payer: Blue Shield of California Commercial |
$71.64
|
| Rate for Payer: Blue Shield of California EPN |
$56.76
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO |
$62.21
|
| Rate for Payer: Cigna of CA PPO |
$71.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.62
|
| Rate for Payer: Dignity Health Media |
$82.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.33
|
| Rate for Payer: Multiplan Commercial |
$77.76
|
| Rate for Payer: Networks By Design Commercial |
$63.18
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.60
|
| Rate for Payer: United Healthcare All Other HMO |
$48.60
|
| Rate for Payer: United Healthcare HMO Rider |
$48.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.62
|
| Rate for Payer: Vantage Medical Group Senior |
$82.62
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-5
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.15
|
| Rate for Payer: Blue Distinction Transplant |
$75.68
|
| Rate for Payer: Blue Shield of California Commercial |
$92.96
|
| Rate for Payer: Blue Shield of California EPN |
$73.66
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cigna of CA HMO |
$80.72
|
| Rate for Payer: Cigna of CA PPO |
$93.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Media |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$94.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.27
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Networks By Design Commercial |
$81.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.06
|
| Rate for Payer: United Healthcare All Other HMO |
$63.06
|
| Rate for Payer: United Healthcare HMO Rider |
$63.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.21
|
| Rate for Payer: Vantage Medical Group Senior |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-11
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$161.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.00
|
| Rate for Payer: Blue Distinction Transplant |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$139.78
|
| Rate for Payer: Blue Shield of California EPN |
$110.76
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$140.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.21
|
| Rate for Payer: Dignity Health Media |
$161.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$142.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.52
|
| Rate for Payer: Multiplan Commercial |
$151.73
|
| Rate for Payer: Networks By Design Commercial |
$123.28
|
| Rate for Payer: Prime Health Services Commercial |
$161.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.83
|
| Rate for Payer: United Healthcare All Other HMO |
$94.83
|
| Rate for Payer: United Healthcare HMO Rider |
$94.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.21
|
| Rate for Payer: Vantage Medical Group Senior |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-5
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Blue Shield of California Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California EPN |
$64.58
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.27
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Networks By Design Commercial |
$81.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-1
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.15
|
| Rate for Payer: Blue Distinction Transplant |
$75.68
|
| Rate for Payer: Blue Shield of California Commercial |
$92.96
|
| Rate for Payer: Blue Shield of California EPN |
$73.66
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cigna of CA HMO |
$80.72
|
| Rate for Payer: Cigna of CA PPO |
$93.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Media |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$94.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.27
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Networks By Design Commercial |
$81.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.06
|
| Rate for Payer: United Healthcare All Other HMO |
$63.06
|
| Rate for Payer: United Healthcare HMO Rider |
$63.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.21
|
| Rate for Payer: Vantage Medical Group Senior |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-25
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$161.21 |
| Rate for Payer: Blue Shield of California Commercial |
$135.04
|
| Rate for Payer: Blue Shield of California EPN |
$97.11
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.52
|
| Rate for Payer: Multiplan Commercial |
$151.73
|
| Rate for Payer: Networks By Design Commercial |
$123.28
|
| Rate for Payer: Prime Health Services Commercial |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-25
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$161.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.00
|
| Rate for Payer: Blue Distinction Transplant |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$139.78
|
| Rate for Payer: Blue Shield of California EPN |
$110.76
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$140.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.21
|
| Rate for Payer: Dignity Health Media |
$161.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$142.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.52
|
| Rate for Payer: Multiplan Commercial |
$151.73
|
| Rate for Payer: Networks By Design Commercial |
$123.28
|
| Rate for Payer: Prime Health Services Commercial |
$161.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.83
|
| Rate for Payer: United Healthcare All Other HMO |
$94.83
|
| Rate for Payer: United Healthcare HMO Rider |
$94.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.21
|
| Rate for Payer: Vantage Medical Group Senior |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-01
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California EPN |
$49.77
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.33
|
| Rate for Payer: Multiplan Commercial |
$77.76
|
| Rate for Payer: Networks By Design Commercial |
$63.18
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-1
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Blue Shield of California Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California EPN |
$64.58
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.27
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Networks By Design Commercial |
$81.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-01
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.91
|
| Rate for Payer: Blue Distinction Transplant |
$58.32
|
| Rate for Payer: Blue Shield of California Commercial |
$71.64
|
| Rate for Payer: Blue Shield of California EPN |
$56.76
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO |
$62.21
|
| Rate for Payer: Cigna of CA PPO |
$71.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.62
|
| Rate for Payer: Dignity Health Media |
$82.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.33
|
| Rate for Payer: Multiplan Commercial |
$77.76
|
| Rate for Payer: Networks By Design Commercial |
$63.18
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.60
|
| Rate for Payer: United Healthcare All Other HMO |
$48.60
|
| Rate for Payer: United Healthcare HMO Rider |
$48.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.62
|
| Rate for Payer: Vantage Medical Group Senior |
$82.62
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
CPT J2598
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California EPN |
$49.77
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO |
$68.04
|
| Rate for Payer: Cigna of CA PPO |
$68.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.33
|
| Rate for Payer: Multiplan Commercial |
$77.76
|
| Rate for Payer: Networks By Design Commercial |
$48.60
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.70
|
| Rate for Payer: United Healthcare All Other HMO |
$35.85
|
| Rate for Payer: United Healthcare HMO Rider |
$35.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.08
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
OP
|
$97.20
|
|
|
Service Code
|
CPT J2598
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.91
|
| Rate for Payer: Blue Distinction Transplant |
$58.32
|
| Rate for Payer: Blue Shield of California Commercial |
$71.64
|
| Rate for Payer: Blue Shield of California EPN |
$56.76
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO |
$68.04
|
| Rate for Payer: Cigna of CA PPO |
$68.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$1.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.98
|
| Rate for Payer: Heritage Provider Network Transplant |
$2.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$77.76
|
| Rate for Payer: Networks By Design Commercial |
$48.60
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.60
|
| Rate for Payer: United Healthcare All Other HMO |
$48.60
|
| Rate for Payer: United Healthcare HMO Rider |
$48.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.82
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
NDC4081064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Distinction Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Media |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
NDC4081064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: Blue Distinction Transplant |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
