|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
IP
|
$232.56
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Blue Shield of California Commercial |
$171.63
|
| Rate for Payer: Blue Shield of California EPN |
$113.02
|
| Rate for Payer: Cash Price |
$127.91
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$143.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Multiplan Commercial |
$186.05
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.28
|
| Rate for Payer: United Healthcare All Other HMO |
$84.95
|
| Rate for Payer: United Healthcare HMO Rider |
$83.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.16
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
OP
|
$232.56
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cash Price |
$127.91
|
| 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 Medi-Cal |
$197.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$143.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.79
|
| 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 |
$87.28
|
| Rate for Payer: United Healthcare All Other HMO |
$84.95
|
| Rate for Payer: United Healthcare HMO Rider |
$83.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.16
|
| 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 ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 9994-0804-46
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.57
|
| 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: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.64
|
| 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 |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Cash Price |
$0.57
|
| 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 Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
IP
|
$218.70
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Adventist Health Commercial |
$43.74
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$106.29
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Cigna of CA HMO |
$153.09
|
| Rate for Payer: Cigna of CA PPO |
$153.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.48
|
| Rate for Payer: EPIC Health Plan Senior |
$87.48
|
| Rate for Payer: Galaxy Health WC |
$185.90
|
| Rate for Payer: Global Benefits Group Commercial |
$131.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.49
|
| Rate for Payer: Multiplan Commercial |
$174.96
|
| Rate for Payer: Networks By Design Commercial |
$109.35
|
| Rate for Payer: Prime Health Services Commercial |
$185.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$79.89
|
| Rate for Payer: United Healthcare HMO Rider |
$78.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.62
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
OP
|
$218.70
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$496.77 |
| Rate for Payer: Adventist Health Commercial |
$43.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.77
|
| Rate for Payer: Blue Shield of California Commercial |
$219.45
|
| Rate for Payer: Blue Shield of California EPN |
$219.45
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Cigna of CA HMO |
$153.09
|
| Rate for Payer: Cigna of CA PPO |
$153.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.48
|
| Rate for Payer: EPIC Health Plan Senior |
$87.48
|
| Rate for Payer: Galaxy Health WC |
$185.90
|
| Rate for Payer: Global Benefits Group Commercial |
$131.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$174.96
|
| Rate for Payer: Networks By Design Commercial |
$109.35
|
| Rate for Payer: Prime Health Services Commercial |
$185.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.08
|
| Rate for Payer: United Healthcare All Other HMO |
$79.89
|
| Rate for Payer: United Healthcare HMO Rider |
$78.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.90
|
| Rate for Payer: Vantage Medical Group Senior |
$185.90
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
IP
|
$258.61
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.72 |
| Max. Negotiated Rate |
$219.82 |
| Rate for Payer: Adventist Health Commercial |
$51.72
|
| Rate for Payer: Blue Shield of California Commercial |
$190.85
|
| Rate for Payer: Blue Shield of California EPN |
$125.68
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Cigna of CA HMO |
$181.03
|
| Rate for Payer: Cigna of CA PPO |
$181.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.44
|
| Rate for Payer: EPIC Health Plan Senior |
$103.44
|
| Rate for Payer: Galaxy Health WC |
$219.82
|
| Rate for Payer: Global Benefits Group Commercial |
$155.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.07
|
| Rate for Payer: Multiplan Commercial |
$206.89
|
| Rate for Payer: Networks By Design Commercial |
$129.31
|
| Rate for Payer: Prime Health Services Commercial |
$219.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.06
|
| Rate for Payer: United Healthcare All Other HMO |
$94.47
|
| Rate for Payer: United Healthcare HMO Rider |
$92.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.69
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
OP
|
$258.61
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.72 |
| Max. Negotiated Rate |
$585.42 |
| Rate for Payer: Adventist Health Commercial |
$51.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.42
|
| Rate for Payer: Blue Shield of California Commercial |
$237.47
|
| Rate for Payer: Blue Shield of California EPN |
$237.47
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Cigna of CA HMO |
$181.03
|
| Rate for Payer: Cigna of CA PPO |
$181.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.44
|
| Rate for Payer: EPIC Health Plan Senior |
$103.44
|
| Rate for Payer: Galaxy Health WC |
$219.82
|
| Rate for Payer: Global Benefits Group Commercial |
$155.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$369.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.03
|
| Rate for Payer: Multiplan Commercial |
$206.89
|
| Rate for Payer: Networks By Design Commercial |
$129.31
|
| Rate for Payer: Prime Health Services Commercial |
$219.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.06
|
| Rate for Payer: United Healthcare All Other HMO |
$94.47
|
| Rate for Payer: United Healthcare HMO Rider |
$92.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.82
|
| Rate for Payer: Vantage Medical Group Senior |
$219.82
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California Commercial |
$44.28
|
| Rate for Payer: Blue Shield of California Commercial |
$17.71
|
| Rate for Payer: Blue Shield of California Commercial |
$93.08
|
| Rate for Payer: Blue Shield of California Commercial |
$20.37
|
| Rate for Payer: Blue Shield of California Commercial |
$15.95
|
| Rate for Payer: Blue Shield of California EPN |
$61.30
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$10.50
|
| Rate for Payer: Blue Shield of California EPN |
$13.41
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cigna of CA HMO |
$19.32
|
| Rate for Payer: Cigna of CA HMO |
$88.29
|
| Rate for Payer: Cigna of CA HMO |
$15.13
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$19.32
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$88.29
|
| Rate for Payer: Cigna of CA PPO |
$15.13
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$18.37
|
| Rate for Payer: Global Benefits Group Commercial |
$12.97
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16.56
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.27
|
| Rate for Payer: Multiplan Commercial |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$13.80
|
| Rate for Payer: Networks By Design Commercial |
$63.06
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Commercial |
$23.46
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$18.37
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare All Other HMO |
$10.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$46.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$45.08
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$9.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.31
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$21.61
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$18.37 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna of CA HMO |
$88.29
|
| Rate for Payer: Cigna of CA HMO |
$15.13
|
| Rate for Payer: Cigna of CA HMO |
$19.32
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$88.29
|
| Rate for Payer: Cigna of CA PPO |
$15.13
|
| Rate for Payer: Cigna of CA PPO |
$19.32
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$50.45
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Galaxy Health WC |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12.97
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16.56
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Networks By Design Commercial |
$63.06
|
| Rate for Payer: Networks By Design Commercial |
$13.80
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Commercial |
$23.46
|
| Rate for Payer: Prime Health Services Commercial |
$18.37
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$46.08
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.08
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.86
|
| Rate for Payer: United Healthcare HMO Rider |
$45.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.72
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$107.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$23.46
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.71
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO |
$16.80
|
| Rate for Payer: Cigna of CA PPO |
$16.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.01
|
| Rate for Payer: United Healthcare All Other HMO |
$8.77
|
| Rate for Payer: United Healthcare HMO Rider |
$8.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.67
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.20
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO |
$4.38
|
| Rate for Payer: Cigna of CA PPO |
$5.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Networks By Design Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.42
|
| Rate for Payer: United Healthcare All Other HMO |
$3.42
|
| Rate for Payer: United Healthcare HMO Rider |
$3.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.53
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.26
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.26
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5.05
|
| Rate for Payer: Blue Shield of California EPN |
$3.32
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2.74
|
| Rate for Payer: Galaxy Health WC |
$5.81
|
| Rate for Payer: Global Benefits Group Commercial |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$5.47
|
| Rate for Payer: Networks By Design Commercial |
$4.45
|
| Rate for Payer: Prime Health Services Commercial |
$5.81
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.53
|
| Rate for Payer: Blue Shield of California EPN |
$4.96
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Senior |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.38
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.41
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna of CA HMO |
$5.64
|
| Rate for Payer: Cigna of CA PPO |
$6.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: EPIC Health Plan Senior |
$3.52
|
| Rate for Payer: Galaxy Health WC |
$7.49
|
| Rate for Payer: Global Benefits Group Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.17
|
| Rate for Payer: Multiplan Commercial |
$7.05
|
| Rate for Payer: Networks By Design Commercial |
$5.73
|
| Rate for Payer: Prime Health Services Commercial |
$7.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Other HMO |
$4.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.24
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO |
$3.38
|
| Rate for Payer: Cigna of CA PPO |
$3.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.11
|
| Rate for Payer: EPIC Health Plan Senior |
$2.11
|
| Rate for Payer: Galaxy Health WC |
$4.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$4.22
|
| Rate for Payer: Networks By Design Commercial |
$3.43
|
| Rate for Payer: Prime Health Services Commercial |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
