|
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
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
IP
|
$95.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$81.09 |
| Rate for Payer: Blue Shield of California Commercial |
$67.92
|
| Rate for Payer: Blue Shield of California Commercial |
$20.82
|
| Rate for Payer: Blue Shield of California Commercial |
$42.71
|
| Rate for Payer: Blue Shield of California EPN |
$30.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.84
|
| Rate for Payer: Blue Shield of California EPN |
$14.97
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.90
|
| Rate for Payer: Multiplan Commercial |
$47.99
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$76.32
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
OP
|
$29.24
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.47
|
| 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 |
$57.24
|
| Rate for Payer: BCBS Transplant Transplant |
$17.54
|
| Rate for Payer: BCBS Transplant Transplant |
$35.99
|
| Rate for Payer: Blue Shield of California Commercial |
$44.21
|
| Rate for Payer: Blue Shield of California Commercial |
$21.55
|
| Rate for Payer: Blue Shield of California Commercial |
$70.31
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: Dignity Health Media |
$81.09
|
| Rate for Payer: Dignity Health Media |
$24.85
|
| Rate for Payer: Dignity Health Media |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.70
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| 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 |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.90
|
| Rate for Payer: Multiplan Commercial |
$47.99
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$76.32
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$47.70
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$47.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
| Rate for Payer: Vantage Medical Group Senior |
$81.09
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Blue Shield of California Commercial |
$2.56
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| 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: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
OP
|
$8.02
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.41
|
| 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 |
$4.81
|
| Rate for Payer: BCBS Transplant Transplant |
$7.08
|
| Rate for Payer: Blue Shield of California Commercial |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5.91
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$8.26
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Media |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.90
|
| Rate for Payer: United Healthcare HMO Rider |
$5.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Blue Shield of California Commercial |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.04
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
OP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.58
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Media |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$0.40
|
| Rate for Payer: United Healthcare HMO Rider |
$0.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
OP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.88
|
| Rate for Payer: BCBS Transplant Transplant |
$139.54
|
| Rate for Payer: Blue Shield of California Commercial |
$171.40
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO |
$162.79
|
| Rate for Payer: Cigna of CA PPO |
$162.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.68
|
| Rate for Payer: Dignity Health Media |
$197.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.02
|
| Rate for Payer: Galaxy Health WC |
$197.68
|
| Rate for Payer: Global Benefits Group Commercial |
$139.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$174.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Multiplan Commercial |
$186.05
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Other HMO |
$116.28
|
| Rate for Payer: United Healthcare HMO Rider |
$116.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.68
|
| Rate for Payer: Vantage Medical Group Senior |
$197.68
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
IP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Blue Shield of California Commercial |
$165.58
|
| Rate for Payer: Blue Shield of California EPN |
$119.07
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO |
$162.79
|
| Rate for Payer: Cigna of CA PPO |
$162.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.02
|
| Rate for Payer: Galaxy Health WC |
$197.68
|
| Rate for Payer: Global Benefits Group Commercial |
$139.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Multiplan Commercial |
$186.05
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
|
|
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
|
|
|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
OP
|
$1.03
|
|
|
Service Code
|
NDC 9994-0804-46
|
| Hospital Charge Code |
1715272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Media |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$5.86
|
| 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
|
|
|
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
|
|
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.68
|
| Rate for Payer: BCBS Transplant 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 Transplant 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
|
|
|
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 70121-1642-5
|
| 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
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
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
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
|
|
