|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
OP
|
$9.65
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cigna of CA HMO |
$6.75
|
| Rate for Payer: Cigna of CA PPO |
$6.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Senior |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.72
|
| Rate for Payer: Networks By Design Commercial |
$4.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3.53
|
| Rate for Payer: United Healthcare HMO Rider |
$3.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$81.09 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| 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 |
$81.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Senior |
$11.70
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$38.16
|
| 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 |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.39
|
| 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: Molina Healthcare of CA Medi-Cal |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$47.99
|
| Rate for Payer: Multiplan Commercial |
$76.32
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Networks By Design Commercial |
$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 |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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: TriValley Medical Group Commercial/Senior |
$17.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$34.85
|
| Rate for Payer: United Healthcare All Other HMO |
$21.91
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$34.10
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| 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 Commercial/Exchange |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| 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 |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
IP
|
$29.24
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California Commercial |
$14.82
|
| Rate for Payer: Blue Shield of California Commercial |
$22.49
|
| Rate for Payer: Blue Shield of California Commercial |
$73.36
|
| Rate for Payer: Blue Shield of California Commercial |
$48.37
|
| Rate for Payer: Blue Shield of California Commercial |
$30.41
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.16
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.29
|
| 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 |
$23.39
|
| Rate for Payer: Multiplan Commercial |
$47.99
|
| Rate for Payer: Multiplan Commercial |
$76.32
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.80
|
| Rate for Payer: United Healthcare All Other HMO |
$34.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$21.91
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$34.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.02
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| 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 Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| 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 |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| 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
|
IP
|
$8.02
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| 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 |
$8.26
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$3.21
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.73
|
| 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 |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.93
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.63
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$5.31
|
| 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: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$3.21
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.96
|
| 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: Molina Healthcare of CA Medi-Cal |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.26
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$2.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994081576
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| 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 9994081576
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.51
|
| 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 Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Senior |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| 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
|
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 |
$117.91
|
| Rate for Payer: Blue Shield of California Commercial |
$178.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$147.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.21
|
| 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 |
$0.03 |
| 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 |
$0.17
|
| 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 Medi-Cal |
$197.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.21
|
| 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
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 9994080446
|
| 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 |
$0.66
|
| 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 Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| 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
|
|
|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 9994080446
|
| 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 |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.61
|
| 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
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
IP
|
$229.64
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Adventist Health Commercial |
$45.93
|
| Rate for Payer: Blue Shield of California Commercial |
$116.43
|
| Rate for Payer: Blue Shield of California Commercial |
$176.59
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cigna of CA HMO |
$160.75
|
| Rate for Payer: Cigna of CA PPO |
$160.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.86
|
| Rate for Payer: EPIC Health Plan Senior |
$91.86
|
| Rate for Payer: Galaxy Health WC |
$195.19
|
| Rate for Payer: Global Benefits Group Commercial |
$137.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.11
|
| Rate for Payer: Multiplan Commercial |
$183.71
|
| Rate for Payer: Networks By Design Commercial |
$114.82
|
| Rate for Payer: Prime Health Services Commercial |
$195.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.18
|
| Rate for Payer: United Healthcare All Other HMO |
$83.89
|
| Rate for Payer: United Healthcare HMO Rider |
$82.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.21
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
OP
|
$229.64
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$1,296.79 |
| Rate for Payer: Adventist Health Commercial |
$45.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,296.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.02
|
| Rate for Payer: Blue Shield of California Commercial |
$219.45
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cigna of CA HMO |
$160.75
|
| Rate for Payer: Cigna of CA PPO |
$160.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.86
|
| Rate for Payer: EPIC Health Plan Senior |
$91.86
|
| Rate for Payer: Galaxy Health WC |
$195.19
|
| Rate for Payer: Global Benefits Group Commercial |
$137.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.75
|
| Rate for Payer: Multiplan Commercial |
$183.71
|
| Rate for Payer: Networks By Design Commercial |
$114.82
|
| Rate for Payer: Prime Health Services Commercial |
$195.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.18
|
| Rate for Payer: United Healthcare All Other HMO |
$83.89
|
| Rate for Payer: United Healthcare HMO Rider |
$82.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.19
|
| Rate for Payer: Vantage Medical Group Senior |
$195.19
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
OP
|
$281.63
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$1,528.23 |
| Rate for Payer: Adventist Health Commercial |
$56.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,528.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.82
|
| Rate for Payer: Blue Shield of California Commercial |
$237.47
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cigna of CA HMO |
$197.14
|
| Rate for Payer: Cigna of CA PPO |
$197.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.65
|
| Rate for Payer: EPIC Health Plan Senior |
$112.65
|
| Rate for Payer: Galaxy Health WC |
$239.39
|
| Rate for Payer: Global Benefits Group Commercial |
$168.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$401.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.14
|
| Rate for Payer: Multiplan Commercial |
$225.30
|
| Rate for Payer: Networks By Design Commercial |
$140.81
|
| Rate for Payer: Prime Health Services Commercial |
$239.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.70
|
| Rate for Payer: United Healthcare All Other HMO |
$102.88
|
| Rate for Payer: United Healthcare HMO Rider |
$100.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.39
|
| Rate for Payer: Vantage Medical Group Senior |
$239.39
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
IP
|
$281.63
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$239.39 |
| Rate for Payer: Adventist Health Commercial |
$56.33
|
| Rate for Payer: Blue Shield of California Commercial |
$142.79
|
| Rate for Payer: Blue Shield of California Commercial |
$216.57
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cigna of CA HMO |
$197.14
|
| Rate for Payer: Cigna of CA PPO |
$197.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.65
|
| Rate for Payer: EPIC Health Plan Senior |
$112.65
|
| Rate for Payer: Galaxy Health WC |
$239.39
|
| Rate for Payer: Global Benefits Group Commercial |
$168.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.59
|
| Rate for Payer: Multiplan Commercial |
$225.30
|
| Rate for Payer: Networks By Design Commercial |
$140.81
|
| Rate for Payer: Prime Health Services Commercial |
$239.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.70
|
| Rate for Payer: United Healthcare All Other HMO |
$102.88
|
| Rate for Payer: United Healthcare HMO Rider |
$100.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.23
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.85
|
| Rate for Payer: Blue Shield of California Commercial |
$11.90
|
| Rate for Payer: Blue Shield of California Commercial |
$96.99
|
| Rate for Payer: Blue Shield of California Commercial |
$10.96
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$16.62
|
| Rate for Payer: Blue Shield of California Commercial |
$21.22
|
| Rate for Payer: Blue Shield of California Commercial |
$63.95
|
| Rate for Payer: Blue Shield of California Commercial |
$13.99
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cigna of CA HMO |
$19.32
|
| Rate for Payer: Cigna of CA HMO |
$15.13
|
| Rate for Payer: Cigna of CA HMO |
$88.29
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| 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 |
$15.13
|
| Rate for Payer: Cigna of CA PPO |
$88.29
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| 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 |
$50.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Galaxy Health WC |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.97
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.19
|
| 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 |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$100.90
|
| Rate for Payer: Multiplan Commercial |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$7.74
|
| 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 |
$18.37
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| 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 |
$5.81
|
| 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 |
$8.11
|
| 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 |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$46.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| 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 HMO Rider |
$9.86
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.07
|
| 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 |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.31
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$126.13
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| 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 |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| 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 |
$10.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| 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: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cigna of CA HMO |
$19.32
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA HMO |
$15.13
|
| Rate for Payer: Cigna of CA HMO |
$88.29
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| 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 |
$88.29
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| 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 |
$6.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Senior |
$8.64
|
| 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 |
$6.19
|
| 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 |
$13.16
|
| Rate for Payer: Galaxy Health WC |
$18.37
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| 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 |
$12.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| 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 |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.13
|
| 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 |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$17.29
|
| 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 |
$7.74
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.37
|
| 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 |
$13.16
|
| 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 |
$9.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.29
|
| 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 |
$12.97
|
| 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 |
$5.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$46.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| 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 |
$7.72
|
| 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 |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.07
|
| 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 |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| 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 |
$18.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| 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 |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
| Rate for Payer: Vantage Medical Group Senior |
$23.46
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$11.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.07
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3.75
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.19
|
| Rate for Payer: Galaxy Health WC |
$13.16
|
| Rate for Payer: Global Benefits Group Commercial |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.84
|
| Rate for Payer: Multiplan Commercial |
$12.38
|
| Rate for Payer: Networks By Design Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Commercial |
$13.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.81
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994081064
|
| 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 |
$0.70
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| 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
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994081064
|
| 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 |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| 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
|
|
