|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
|
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
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
|
|
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
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
IP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-11
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$142.24
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| 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: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.69
|
| 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
|
|
|
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
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
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
IP
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-25
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$142.24
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| 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: EPIC Health Plan Commercial |
$75.86
|
| Rate for Payer: Galaxy Health WC |
$161.21
|
| Rate for Payer: Global Benefits Group Commercial |
$113.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.69
|
| 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
|
|
|
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-10
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$51.90
|
| 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: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.48
|
| 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
|
|
|
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
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 |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| 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: 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
|
$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: Vantage Medical Group Senior |
$107.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.52
|
| Rate for Payer: BCBS Transplant Transplant |
$75.68
|
| Rate for Payer: Blue Shield of California Commercial |
$79.34
|
| Rate for Payer: Blue Shield of California EPN |
$61.68
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Central Health Plan Commercial |
$100.90
|
| Rate for Payer: Cigna of CA HMO |
$80.72
|
| Rate for Payer: Cigna of CA PPO |
$93.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$94.60
|
| Rate for Payer: IEHP medi-cal |
$44.15
|
| 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
|
| Rate for Payer: Riverside University Health MISP |
$50.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.06
|
| Rate for Payer: United Healthcare All Other HMO |
$63.06
|
| Rate for Payer: United Healthcare HMO Rider |
$63.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
OP
|
$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: Aetna of CA HMO/PPO |
$76.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.52
|
| Rate for Payer: BCBS Transplant Transplant |
$75.68
|
| Rate for Payer: Blue Shield of California Commercial |
$79.34
|
| Rate for Payer: Blue Shield of California EPN |
$61.68
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Central Health Plan Commercial |
$100.90
|
| Rate for Payer: Cigna of CA HMO |
$80.72
|
| Rate for Payer: Cigna of CA PPO |
$93.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$94.60
|
| Rate for Payer: IEHP medi-cal |
$44.15
|
| 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
|
| Rate for Payer: Riverside University Health MISP |
$50.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.06
|
| Rate for Payer: United Healthcare All Other HMO |
$63.06
|
| Rate for Payer: United Healthcare HMO Rider |
$63.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.21
|
| Rate for Payer: Vantage Medical Group Senior |
$107.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
IP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-01
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$51.90
|
| 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: EPIC Health Plan Commercial |
$38.88
|
| Rate for Payer: Galaxy Health WC |
$82.62
|
| Rate for Payer: Global Benefits Group Commercial |
$58.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.48
|
| 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
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
OP
|
$97.20
|
|
|
Service Code
|
NDC 42023-164-01
|
| 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 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
IP
|
$97.20
|
|
|
Service Code
|
CPT J2598
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$51.90
|
| 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 |
$68.04
|
| Rate for Payer: Cigna of CA PPO |
$68.04
|
| 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: 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 |
$48.60
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
OP
|
$97.20
|
|
|
Service Code
|
CPT J2598
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.00
|
| 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: Caremore Medicare Advantage |
$1.82
|
| 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 |
$68.04
|
| Rate for Payer: Cigna of CA PPO |
$68.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.82
|
| 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: Heritage Provider Network Commercial/Senior |
$2.98
|
| Rate for Payer: IEHP medi-cal |
$2.99
|
| Rate for Payer: IEHP Medicare Advantage |
$1.82
|
| Rate for Payer: Innovage PACE Commercial |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
| Rate for Payer: Networks By Design Commercial |
$48.60
|
| Rate for Payer: Prime Health Services Commercial |
$82.62
|
| Rate for Payer: Prime Health Services Medicare |
$1.92
|
| Rate for Payer: Riverside University Health MISP |
$2.00
|
| 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 Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1.82
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
NDC4081064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
