|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
OP
|
$0.15
|
|
|
Service Code
|
NDC 68094-701-61
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: BCBS Transplant Transplant |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| 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 |
$0.13
|
| Rate for Payer: Dignity Health Media |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.10
|
| 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 |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.09
|
| 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 |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 0121-1350-10
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
IP
|
$508.13
|
|
|
Service Code
|
CPT J9357
|
| Hospital Charge Code |
NDG24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$431.91 |
| Rate for Payer: Blue Shield of California Commercial |
$361.79
|
| Rate for Payer: Blue Shield of California EPN |
$260.16
|
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Cigna of CA HMO |
$355.69
|
| Rate for Payer: Cigna of CA PPO |
$355.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$203.25
|
| Rate for Payer: Galaxy Health WC |
$431.91
|
| Rate for Payer: Global Benefits Group Commercial |
$304.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.95
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: Networks By Design Commercial |
$254.06
|
| Rate for Payer: Prime Health Services Commercial |
$431.91
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
OP
|
$508.13
|
|
|
Service Code
|
CPT J9357
|
| Hospital Charge Code |
NDG24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$8,577.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,577.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,704.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,500.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,500.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$984.75
|
| Rate for Payer: BCBS Transplant Transplant |
$304.88
|
| Rate for Payer: Blue Shield of California Commercial |
$374.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,687.20
|
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Cigna of CA HMO |
$355.69
|
| Rate for Payer: Cigna of CA PPO |
$355.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,045.77
|
| Rate for Payer: Dignity Health Media |
$1,363.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,500.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,841.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,363.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,363.85
|
| Rate for Payer: Galaxy Health WC |
$431.91
|
| Rate for Payer: Global Benefits Group Commercial |
$304.88
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$381.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,236.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,236.71
|
| Rate for Payer: IEHP Medi-Cal |
$2,209.43
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,209.43
|
| Rate for Payer: IEHP Medicare Advantage |
$1,363.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,718.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,827.56
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: Networks By Design Commercial |
$254.06
|
| Rate for Payer: Prime Health Services Commercial |
$431.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.06
|
| Rate for Payer: United Healthcare All Other HMO |
$254.06
|
| Rate for Payer: United Healthcare HMO Rider |
$254.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,045.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,500.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,363.85
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
IP
|
$19.08
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1717199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Blue Shield of California Commercial |
$13.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$13.71
|
| Rate for Payer: Blue Shield of California EPN |
$9.86
|
| Rate for Payer: Blue Shield of California EPN |
$9.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$13.36
|
| Rate for Payer: Cigna of CA HMO |
$13.48
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$13.36
|
| Rate for Payer: Cigna of CA PPO |
$13.48
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.63
|
| Rate for Payer: Galaxy Health WC |
$16.36
|
| Rate for Payer: Galaxy Health WC |
$16.22
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Global Benefits Group Commercial |
$11.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$5.75
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Networks By Design Commercial |
$9.62
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Prime Health Services Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
OP
|
$19.25
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1717199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cigna of CA HMO |
$13.48
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$13.36
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$13.36
|
| Rate for Payer: Cigna of CA PPO |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$16.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.95
|
| 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: BCBS Transplant Transplant |
$4.31
|
| Rate for Payer: BCBS Transplant Transplant |
$11.45
|
| Rate for Payer: BCBS Transplant Transplant |
$11.55
|
| Rate for Payer: Blue Shield of California Commercial |
$14.06
|
| Rate for Payer: Blue Shield of California Commercial |
$14.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.22
|
| Rate for Payer: Dignity Health Media |
$16.36
|
| Rate for Payer: Dignity Health Media |
$6.11
|
| Rate for Payer: Dignity Health Media |
$16.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.70
|
| Rate for Payer: Galaxy Health WC |
$16.22
|
| Rate for Payer: Galaxy Health WC |
$16.36
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.31
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| 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 |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$15.40
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$9.62
|
| Rate for Payer: Prime Health Services Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.62
|
| Rate for Payer: United Healthcare All Other HMO |
$9.54
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.62
|
| Rate for Payer: United Healthcare HMO Rider |
$9.62
|
| Rate for Payer: United Healthcare HMO Rider |
$9.54
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.22
|
| Rate for Payer: Vantage Medical Group Senior |
$16.36
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
IP
|
$260.68
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.56 |
| Max. Negotiated Rate |
$221.58 |
| Rate for Payer: Blue Shield of California Commercial |
$185.60
|
| Rate for Payer: Blue Shield of California Commercial |
$181.56
|
| Rate for Payer: Blue Shield of California Commercial |
$68.35
|
| Rate for Payer: Blue Shield of California EPN |
$49.15
|
| Rate for Payer: Blue Shield of California EPN |
$130.56
|
| Rate for Payer: Blue Shield of California EPN |
$133.47
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$178.50
|
| Rate for Payer: Cigna of CA HMO |
$182.48
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$178.50
|
| Rate for Payer: Cigna of CA PPO |
$182.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$221.58
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$156.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$208.54
|
| Rate for Payer: Networks By Design Commercial |
$130.34
|
| Rate for Payer: Networks By Design Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.58
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$81.60 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$221.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$143.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.80
|
| 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: BCBS Transplant Transplant |
$57.60
|
| Rate for Payer: BCBS Transplant Transplant |
$153.00
|
| Rate for Payer: BCBS Transplant Transplant |
$156.41
|
| Rate for Payer: Blue Shield of California Commercial |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$187.94
|
| Rate for Payer: Blue Shield of California Commercial |
$192.12
|
| 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 |
$117.31
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO |
$182.48
|
| Rate for Payer: Cigna of CA HMO |
$178.50
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$182.48
|
| Rate for Payer: Cigna of CA PPO |
$178.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Media |
$216.75
|
| Rate for Payer: Dignity Health Media |
$81.60
|
| Rate for Payer: Dignity Health Media |
$221.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Galaxy Health WC |
$221.58
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.41
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$195.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$191.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.87
|
| 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: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$208.54
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$130.34
|
| Rate for Payer: Networks By Design Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Commercial |
$221.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other HMO |
$130.34
|
| Rate for Payer: United Healthcare All Other HMO |
$127.50
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$127.50
|
| Rate for Payer: United Healthcare HMO Rider |
$130.34
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.58
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$221.58
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: BCBS Transplant 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 Transplant 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 [92895]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2227
|
|
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
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: BCBS Transplant 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 Transplant 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 [92895]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2226
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: BCBS Transplant 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 Transplant 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 [92895]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2226
|
|
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
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| 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
|
|
|
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: 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: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: BCBS Transplant 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: 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 Transplant 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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$5.04
|
| 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
|
$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/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: AlphaCare Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.88
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3.91
|
| 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
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
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: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.83
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$5.87
|
| 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
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 INTRAVENOUS SOLUTION [8443]
|
Facility
IP
|
$9.79
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Blue Shield of California EPN |
$5.01
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| 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 |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| 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 |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Galaxy Health WC |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| 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 |
$5.60
|
| 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 Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
OP
|
$8.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| 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: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| 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: BCBS Transplant Transplant |
$5.87
|
| Rate for Payer: BCBS Transplant Transplant |
$5.79
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| 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 |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$8.20
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Media |
$7.14
|
| Rate for Payer: Dignity Health Media |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| 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 |
$3.92
|
| 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 |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| 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 |
$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: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| 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 |
$8.32
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| 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 |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| 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 HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| 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 |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| 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 |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
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: 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: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| 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: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$5.79
|
| Rate for Payer: BCBS Transplant Transplant |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.19
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| 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 |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| 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 |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| 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 |
$7.14
|
| Rate for Payer: Dignity Health Media |
$8.20
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| 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 |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| 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 |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| 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 Transplant Other |
$7.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| 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 |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$6.72
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| 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 |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| 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 HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| 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 |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| 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 Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
