|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
IP
|
$9.79
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Blue Shield of California Commercial |
$7.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7.24
|
| Rate for Payer: Blue Shield of California EPN |
$5.23
|
| Rate for Payer: Blue Shield of California EPN |
$5.15
|
| Rate for Payer: Blue Shield of California EPN |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Central Health Plan Commercial |
$7.72
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$7.83
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: BCBS Transplant Transplant |
$5.87
|
| Rate for Payer: BCBS Transplant Transplant |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Central Health Plan Commercial |
$7.72
|
| Rate for Payer: Central Health Plan Commercial |
$7.83
|
| Rate for Payer: Central Health Plan Commercial |
$6.72
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$6.76
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA HMO |
$6.85
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.76
|
| Rate for Payer: Cigna of CA PPO |
$6.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.92
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Galaxy Health WC |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$8.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.87
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.24
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Networks By Design Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Prime Health Services Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$8.32
|
| Rate for Payer: Riverside University Health MISP |
$3.92
|
| Rate for Payer: Riverside University Health MISP |
$1.44
|
| Rate for Payer: Riverside University Health MISP |
$3.86
|
| Rate for Payer: Riverside University Health MISP |
$3.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
OP
|
$59.99
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$53.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: BCBS Transplant Transplant |
$17.54
|
| Rate for Payer: BCBS Transplant Transplant |
$57.24
|
| Rate for Payer: BCBS Transplant Transplant |
$35.99
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Central Health Plan Commercial |
$47.99
|
| Rate for Payer: Central Health Plan Commercial |
$23.39
|
| Rate for Payer: Central Health Plan Commercial |
$76.32
|
| 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 |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.70
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.86
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$71.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.93
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| 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: Riverside University Health MISP |
$38.16
|
| Rate for Payer: Riverside University Health MISP |
$24.00
|
| Rate for Payer: Riverside University Health MISP |
$11.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.54
|
| 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: TriValley Medical Group Commercial/Senior |
$57.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$47.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$47.70
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
| Rate for Payer: Vantage Medical Group Senior |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
IP
|
$59.99
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$53.99 |
| Rate for Payer: Blue Shield of California Commercial |
$44.99
|
| Rate for Payer: Blue Shield of California Commercial |
$21.93
|
| Rate for Payer: Blue Shield of California Commercial |
$71.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.94
|
| Rate for Payer: Blue Shield of California EPN |
$15.61
|
| Rate for Payer: Blue Shield of California EPN |
$32.03
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Central Health Plan Commercial |
$23.39
|
| Rate for Payer: Central Health Plan Commercial |
$47.99
|
| Rate for Payer: Central Health Plan Commercial |
$76.32
|
| Rate for Payer: Cigna of CA HMO |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$20.47
|
| Rate for Payer: Cigna of CA HMO |
$66.78
|
| Rate for Payer: Cigna of CA PPO |
$20.47
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Cigna of CA PPO |
$66.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$50.99
|
| Rate for Payer: Galaxy Health WC |
$81.09
|
| Rate for Payer: Galaxy Health WC |
$24.85
|
| Rate for Payer: Global Benefits Group Commercial |
$57.24
|
| Rate for Payer: Global Benefits Group Commercial |
$17.54
|
| Rate for Payer: Global Benefits Group Commercial |
$35.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Networks By Design Commercial |
$47.70
|
| Rate for Payer: Prime Health Services Commercial |
$81.09
|
| Rate for Payer: Prime Health Services Commercial |
$24.85
|
| Rate for Payer: Prime Health Services Commercial |
$50.99
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Blue Shield of California Commercial |
$2.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: BCBS Transplant Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.70
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$1.80
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| 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: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| 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: Riverside University Health MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
OP
|
$8.02
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: BCBS Transplant Transplant |
$7.08
|
| Rate for Payer: BCBS Transplant Transplant |
$4.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Central Health Plan Commercial |
$9.44
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$8.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| 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: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.02
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Riverside University Health MISP |
$4.72
|
| Rate for Payer: Riverside University Health MISP |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$5.90
|
| Rate for Payer: United Healthcare HMO Rider |
$5.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.90
|
| Rate for Payer: Vantage Medical Group 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 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Blue Shield of California Commercial |
$6.02
|
| Rate for Payer: Blue Shield of California Commercial |
$8.85
|
| Rate for Payer: Blue Shield of California EPN |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.28
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$6.42
|
| Rate for Payer: Central Health Plan Commercial |
$9.44
|
| Rate for Payer: Cigna of CA HMO |
$8.26
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.03
|
| Rate for Payer: Galaxy Health WC |
$6.82
|
| Rate for Payer: Global Benefits Group Commercial |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$7.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: Networks By Design Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.01
|
| Rate for Payer: Prime Health Services Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$10.03
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
OP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.47
|
| Rate for Payer: BCBS Transplant Transplant |
$0.47
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| 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: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.59
|
| Rate for Payer: IEHP medi-cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
| Rate for Payer: Riverside University Health MISP |
$0.32
|
| 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 Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Blue Shield of California Commercial |
$0.59
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: Galaxy Health WC |
$0.67
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.67
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
IP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Blue Shield of California Commercial |
$174.42
|
| Rate for Payer: Blue Shield of California EPN |
$124.19
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Central Health Plan Commercial |
$186.05
|
| Rate for Payer: Cigna of CA HMO |
$162.79
|
| Rate for Payer: Cigna of CA PPO |
$162.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.02
|
| Rate for Payer: Galaxy Health WC |
$197.68
|
| Rate for Payer: Global Benefits Group Commercial |
$139.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.51
|
| Rate for Payer: Multiplan Commercial |
$174.42
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
OP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$127.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.43
|
| Rate for Payer: BCBS Transplant Transplant |
$139.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8.46
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Central Health Plan Commercial |
$186.05
|
| 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: EPIC Health Plan Commercial |
$93.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.02
|
| Rate for Payer: Galaxy Health WC |
$197.68
|
| Rate for Payer: Global Benefits Group Commercial |
$139.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$174.42
|
| Rate for Payer: IEHP medi-cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.51
|
| Rate for Payer: Multiplan Commercial |
$174.42
|
| Rate for Payer: Networks By Design Commercial |
$116.28
|
| Rate for Payer: Prime Health Services Commercial |
$197.68
|
| Rate for Payer: Riverside University Health MISP |
$93.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Other HMO |
$116.28
|
| Rate for Payer: United Healthcare HMO Rider |
$116.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.28
|
| Rate for Payer: Vantage Medical Group 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 9994-0804-46
|
| Hospital Charge Code |
1715272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| 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: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.77
|
| Rate for Payer: IEHP medi-cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: Riverside University Health MISP |
$0.41
|
| 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 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 9994-0804-46
|
| Hospital Charge Code |
1715272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Central Health Plan Commercial |
$0.82
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
VARENICLINE 0.5 MG TABLET [76444]
|
Facility
OP
|
$9.76
|
|
|
Service Code
|
NDC 0069-0468-56
|
| Hospital Charge Code |
1712341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.77
|
| Rate for Payer: BCBS Transplant Transplant |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$4.77
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Central Health Plan Commercial |
$7.81
|
| Rate for Payer: Cigna of CA HMO |
$6.83
|
| Rate for Payer: Cigna of CA PPO |
$6.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.32
|
| Rate for Payer: IEHP medi-cal |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: Riverside University Health MISP |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4.88
|
| Rate for Payer: United Healthcare HMO Rider |
$4.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
VARENICLINE 0.5 MG TABLET [76444]
|
Facility
IP
|
$9.76
|
|
|
Service Code
|
NDC 0069-0468-56
|
| Hospital Charge Code |
1712341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.21
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Central Health Plan Commercial |
$7.81
|
| Rate for Payer: Cigna of CA HMO |
$6.83
|
| Rate for Payer: Cigna of CA PPO |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
OP
|
$191.09
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
1721059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$1,090.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,090.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.97
|
| Rate for Payer: BCBS Transplant Transplant |
$114.65
|
| Rate for Payer: Blue Shield of California Commercial |
$187.90
|
| Rate for Payer: Blue Shield of California EPN |
$170.82
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Central Health Plan Commercial |
$152.87
|
| Rate for Payer: Cigna of CA HMO |
$133.76
|
| Rate for Payer: Cigna of CA PPO |
$133.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.44
|
| Rate for Payer: Galaxy Health WC |
$162.43
|
| Rate for Payer: Global Benefits Group Commercial |
$114.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$143.32
|
| Rate for Payer: IEHP medi-cal |
$66.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.22
|
| Rate for Payer: Multiplan Commercial |
$143.32
|
| Rate for Payer: Networks By Design Commercial |
$95.54
|
| Rate for Payer: Prime Health Services Commercial |
$162.43
|
| Rate for Payer: Riverside University Health MISP |
$76.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.54
|
| Rate for Payer: United Healthcare All Other HMO |
$95.54
|
| Rate for Payer: United Healthcare HMO Rider |
$95.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.43
|
| Rate for Payer: Vantage Medical Group Senior |
$162.43
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
IP
|
$191.09
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
1721059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$171.98 |
| Rate for Payer: Blue Shield of California Commercial |
$143.32
|
| Rate for Payer: Blue Shield of California EPN |
$102.04
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Central Health Plan Commercial |
$152.87
|
| Rate for Payer: Cigna of CA HMO |
$133.76
|
| Rate for Payer: Cigna of CA PPO |
$133.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.44
|
| Rate for Payer: Galaxy Health WC |
$162.43
|
| Rate for Payer: Global Benefits Group Commercial |
$114.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.22
|
| Rate for Payer: Multiplan Commercial |
$143.32
|
| Rate for Payer: Networks By Design Commercial |
$95.54
|
| Rate for Payer: Prime Health Services Commercial |
$162.43
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
OP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-11
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$170.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$104.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.05
|
| Rate for Payer: BCBS Transplant Transplant |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$119.30
|
| Rate for Payer: Blue Shield of California EPN |
$92.74
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Central Health Plan Commercial |
$151.73
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$140.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$142.24
|
| Rate for Payer: IEHP medi-cal |
$66.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.93
|
| Rate for Payer: Multiplan Commercial |
$142.24
|
| Rate for Payer: Networks By Design Commercial |
$123.28
|
| Rate for Payer: Prime Health Services Commercial |
$161.21
|
| Rate for Payer: Riverside University Health MISP |
$75.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.83
|
| Rate for Payer: United Healthcare All Other HMO |
$94.83
|
| Rate for Payer: United Healthcare HMO Rider |
$94.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.21
|
| Rate for Payer: Vantage Medical Group Senior |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
OP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-10
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.43
|
| Rate for Payer: BCBS Transplant Transplant |
$58.32
|
| Rate for Payer: Blue Shield of California Commercial |
$61.14
|
| Rate for Payer: Blue Shield of California EPN |
$47.53
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Central Health Plan Commercial |
$77.76
|
| Rate for Payer: Cigna of CA HMO |
$62.21
|
| Rate for Payer: Cigna of CA PPO |
$71.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.90
|
| Rate for Payer: IEHP medi-cal |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
| Rate for Payer: Networks By Design Commercial |
$63.18
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
| Rate for Payer: Riverside University Health MISP |
$38.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.60
|
| Rate for Payer: United Healthcare All Other HMO |
$48.60
|
| Rate for Payer: United Healthcare HMO Rider |
$48.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.62
|
| Rate for Payer: Vantage Medical Group Senior |
$82.62
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
IP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-5
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.23 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Blue Shield of California Commercial |
$94.60
|
| Rate for Payer: Blue Shield of California EPN |
$67.35
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Central Health Plan Commercial |
$100.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.23
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Networks By Design Commercial |
$81.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
IP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-1
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.23 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Blue Shield of California Commercial |
$94.60
|
| Rate for Payer: Blue Shield of California EPN |
$67.35
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Central Health Plan Commercial |
$100.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: Galaxy Health WC |
$107.21
|
| Rate for Payer: Global Benefits Group Commercial |
$75.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.23
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Networks By Design Commercial |
$81.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
OP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-25
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$170.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$104.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.05
|
| Rate for Payer: BCBS Transplant Transplant |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$119.30
|
| Rate for Payer: Blue Shield of California EPN |
$92.74
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Central Health Plan Commercial |
$151.73
|
| Rate for Payer: Cigna of CA HMO |
$121.38
|
| Rate for Payer: Cigna of CA PPO |
$140.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$142.24
|
| Rate for Payer: IEHP medi-cal |
$66.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.93
|
| Rate for Payer: Multiplan Commercial |
$142.24
|
| Rate for Payer: Networks By Design Commercial |
$123.28
|
| Rate for Payer: Prime Health Services Commercial |
$161.21
|
| Rate for Payer: Riverside University Health MISP |
$75.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.83
|
| Rate for Payer: United Healthcare All Other HMO |
$94.83
|
| Rate for Payer: United Healthcare HMO Rider |
$94.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.21
|
| Rate for Payer: Vantage Medical Group Senior |
$161.21
|
|
