|
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 |
$5.67 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.68
|
| Rate for Payer: Dignity Health Senior |
$197.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.68
|
| Rate for Payer: Heritage Provider Network Senior |
$107.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.09
|
| 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: TriValley Medical Group Commercial |
$93.02
|
| Rate for Payer: TriValley Medical Group Senior |
$93.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.68
|
| Rate for Payer: Vantage Medical Group Senior |
$197.68
|
|
|
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 |
$42.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.77
|
| Rate for Payer: Cash Price |
$104.65
|
| 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 |
$157.44
|
| Rate for Payer: Heritage Provider Network Senior |
$157.44
|
| 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 |
$84.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.70
|
|
|
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 |
$0.19 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
|
|
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 |
$0.19 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Senior |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.41
|
| Rate for Payer: TriValley Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$1.77 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.71
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.61
|
| Rate for Payer: Heritage Provider Network Senior |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
|
|
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 |
$1.77 |
| Max. Negotiated Rate |
$8.30 |
| Rate for Payer: Adventist Health Commercial |
$1.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.32
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$5.73
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.30
|
| Rate for Payer: Dignity Health Senior |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.04
|
| Rate for Payer: Heritage Provider Network Senior |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.90
|
| Rate for Payer: TriValley Medical Group Senior |
$3.90
|
| 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
|
OP
|
$191.09
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
1721059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$432.17 |
| Rate for Payer: Adventist Health Commercial |
$38.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.04
|
| Rate for Payer: Blue Shield of California Commercial |
$163.06
|
| Rate for Payer: Blue Shield of California EPN |
$163.06
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.43
|
| Rate for Payer: Dignity Health Senior |
$162.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.47
|
| Rate for Payer: Heritage Provider Network Senior |
$88.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.77
|
| Rate for Payer: Multiplan Commercial |
$143.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.44
|
| Rate for Payer: TriValley Medical Group Senior |
$76.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.43
|
| Rate for Payer: Vantage Medical Group Senior |
$162.43
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
IP
|
$191.09
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
1721059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$143.32 |
| Rate for Payer: Adventist Health Commercial |
$38.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.28
|
| Rate for Payer: Cash Price |
$85.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.77
|
| Rate for Payer: Multiplan Commercial |
$143.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.84
|
|
|
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 |
$34.33 |
| Max. Negotiated Rate |
$161.21 |
| Rate for Payer: Adventist Health Commercial |
$37.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.24
|
| Rate for Payer: Blue Shield of California Commercial |
$117.78
|
| Rate for Payer: Blue Shield of California EPN |
$111.33
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$123.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.21
|
| Rate for Payer: Dignity Health Senior |
$161.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.40
|
| Rate for Payer: Heritage Provider Network Senior |
$117.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$142.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.86
|
| Rate for Payer: TriValley Medical Group Senior |
$75.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.21
|
| Rate for Payer: Vantage Medical Group Senior |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-1
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.83 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.60
|
| Rate for Payer: Blue Shield of California Commercial |
$78.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.04
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: Dignity Health Senior |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.07
|
| Rate for Payer: Heritage Provider Network Senior |
$78.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.45
|
| Rate for Payer: TriValley Medical Group Senior |
$50.45
|
| 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
|
$189.66
|
|
|
Service Code
|
NDC 43598-085-25
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$142.24 |
| Rate for Payer: Adventist Health Commercial |
$37.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.30
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.40
|
| Rate for Payer: Heritage Provider Network Senior |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$142.24
|
|
|
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 |
$17.59 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Adventist Health Commercial |
$19.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.90
|
| Rate for Payer: Blue Shield of California Commercial |
$60.36
|
| Rate for Payer: Blue Shield of California EPN |
$57.06
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.62
|
| Rate for Payer: Dignity Health Senior |
$82.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.17
|
| Rate for Payer: Heritage Provider Network Senior |
$60.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.88
|
| Rate for Payer: TriValley Medical Group Senior |
$38.88
|
| 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 |
$34.33 |
| Max. Negotiated Rate |
$161.21 |
| Rate for Payer: Adventist Health Commercial |
$37.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$104.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.24
|
| Rate for Payer: Blue Shield of California Commercial |
$117.78
|
| Rate for Payer: Blue Shield of California EPN |
$111.33
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$123.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$161.21
|
| Rate for Payer: Dignity Health Senior |
$161.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.40
|
| Rate for Payer: Heritage Provider Network Senior |
$117.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$142.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.86
|
| Rate for Payer: TriValley Medical Group Senior |
$75.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$161.21
|
| Rate for Payer: Vantage Medical Group Senior |
$161.21
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-5
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.83 |
| Max. Negotiated Rate |
$107.21 |
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.60
|
| Rate for Payer: Blue Shield of California Commercial |
$78.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.04
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: Dignity Health Senior |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.07
|
| Rate for Payer: Heritage Provider Network Senior |
$78.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.45
|
| Rate for Payer: TriValley Medical Group Senior |
$50.45
|
| 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 42023-164-10
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$19.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.78
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.80
|
| Rate for Payer: Heritage Provider Network Senior |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
|
|
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 |
$22.83 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.65
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.39
|
| Rate for Payer: Heritage Provider Network Senior |
$85.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
|
|
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 |
$34.33 |
| Max. Negotiated Rate |
$142.24 |
| Rate for Payer: Adventist Health Commercial |
$37.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.30
|
| Rate for Payer: Cash Price |
$85.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.40
|
| Rate for Payer: Heritage Provider Network Senior |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$142.24
|
|
|
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 |
$17.59 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Adventist Health Commercial |
$19.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.90
|
| Rate for Payer: Blue Shield of California Commercial |
$60.36
|
| Rate for Payer: Blue Shield of California EPN |
$57.06
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.62
|
| Rate for Payer: Dignity Health Senior |
$82.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.17
|
| Rate for Payer: Heritage Provider Network Senior |
$60.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.88
|
| Rate for Payer: TriValley Medical Group Senior |
$38.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.62
|
| Rate for Payer: Vantage Medical Group Senior |
$82.62
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$126.13
|
|
|
Service Code
|
NDC 70121-1642-1
|
| Hospital Charge Code |
1757294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.83 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.65
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.39
|
| Rate for Payer: Heritage Provider Network Senior |
$85.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
|
|
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 |
$17.59 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$19.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.78
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.80
|
| Rate for Payer: Heritage Provider Network Senior |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
|
|
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 |
$17.59 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$19.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.78
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.80
|
| Rate for Payer: Heritage Provider Network Senior |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.47
|
|
|
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 |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$19.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$60.36
|
| Rate for Payer: Blue Shield of California EPN |
$57.06
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cash Price |
$43.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.00
|
| Rate for Payer: Dignity Health Senior |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$1.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Senior |
$45.00
|
| Rate for Payer: Humana Medicare |
$1.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$72.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.88
|
| Rate for Payer: TriValley Medical Group Senior |
$38.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.47
|
| 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
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
NDC4081064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Senior |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
NDC4081064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
