|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK PER PHARMACY [40892895]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK PER PHARMACY [40892895]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
IP
|
$6.51
|
|
|
Service Code
|
NDC 0409-6534-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$6.51
|
|
|
Service Code
|
NDC 0409-6534-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.53
|
| Rate for Payer: Dignity Health Senior |
$5.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Senior |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.53
|
| Rate for Payer: Vantage Medical Group Senior |
$5.53
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6.63
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.92
|
| Rate for Payer: TriValley Medical Group Senior |
$3.92
|
| Rate for Payer: TriValley Medical Group Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
OP
|
$9.79
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$3.01
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.42
|
| Rate for Payer: TriValley Medical Group Senior |
$1.42
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$3.92
|
| Rate for Payer: TriValley Medical Group Senior |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| 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 Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.17
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
IP
|
$9.79
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.88
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.92
|
| Rate for Payer: TriValley Medical Group Senior |
$3.36
|
| Rate for Payer: TriValley Medical Group Senior |
$3.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
IP
|
$9.65
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.20
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
|
OP
|
$9.65
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.89
|
| Rate for Payer: Blue Shield of California EPN |
$4.71
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Senior |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.86
|
| Rate for Payer: TriValley Medical Group Senior |
$3.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
IP
|
$59.99
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$44.99 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Cash Price |
$52.47
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$44.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
OP
|
$59.99
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$50.99 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California Commercial |
$58.19
|
| Rate for Payer: Blue Shield of California Commercial |
$36.59
|
| Rate for Payer: Blue Shield of California EPN |
$14.27
|
| Rate for Payer: Blue Shield of California EPN |
$46.56
|
| Rate for Payer: Blue Shield of California EPN |
$29.28
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Cash Price |
$52.47
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cash Price |
$52.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.85
|
| Rate for Payer: Dignity Health Senior |
$50.99
|
| Rate for Payer: Dignity Health Senior |
$81.09
|
| Rate for Payer: Dignity Health Senior |
$24.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$44.17
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Senior |
$38.16
|
| Rate for Payer: TriValley Medical Group Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Senior |
$11.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California EPN |
$3.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Senior |
$10.03
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Senior |
$5.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.26
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Senior |
$4.72
|
| Rate for Payer: TriValley Medical Group Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Senior |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
IP
|
$232.56
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.68
|
| Rate for Payer: Heritage Provider Network Senior |
$107.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.14
|
| Rate for Payer: Multiplan Commercial |
$174.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.00
|
|
