|
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
|
|
|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 9994-0804-46
|
| Hospital Charge Code |
901700029
|
|
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: Cash Price |
$0.57
|
| 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 |
901700029
|
|
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 |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.57
|
| 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 |
$0.49
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.72
|
| 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: United Healthcare All Other HMO/non HMO |
$0.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
OP
|
$218.70
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$473.64 |
| Rate for Payer: Adventist Health Commercial |
$43.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.64
|
| Rate for Payer: Blue Shield of California Commercial |
$186.53
|
| Rate for Payer: Blue Shield of California EPN |
$186.53
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.90
|
| Rate for Payer: Dignity Health Senior |
$185.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.26
|
| Rate for Payer: Heritage Provider Network Senior |
$101.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$104.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$164.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$87.48
|
| Rate for Payer: TriValley Medical Group Senior |
$87.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.90
|
| Rate for Payer: Vantage Medical Group Senior |
$185.90
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
IP
|
$218.70
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$164.03 |
| Rate for Payer: Adventist Health Commercial |
$43.74
|
| Rate for Payer: Cash Price |
$120.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.26
|
| Rate for Payer: Heritage Provider Network Senior |
$101.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.67
|
| Rate for Payer: Multiplan Commercial |
$164.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.41
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
OP
|
$258.61
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$558.16 |
| Rate for Payer: Adventist Health Commercial |
$51.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$558.16
|
| Rate for Payer: Blue Shield of California Commercial |
$201.85
|
| Rate for Payer: Blue Shield of California EPN |
$201.85
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.82
|
| Rate for Payer: Dignity Health Senior |
$219.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.74
|
| Rate for Payer: Heritage Provider Network Senior |
$119.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$356.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.03
|
| Rate for Payer: Multiplan Commercial |
$193.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$103.44
|
| Rate for Payer: TriValley Medical Group Senior |
$103.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.82
|
| Rate for Payer: Vantage Medical Group Senior |
$219.82
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
IP
|
$258.61
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$193.96 |
| Rate for Payer: Adventist Health Commercial |
$51.72
|
| Rate for Payer: Cash Price |
$142.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.74
|
| Rate for Payer: Heritage Provider Network Senior |
$119.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$193.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.63
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Senior |
$51.00
|
| Rate for Payer: Dignity Health Senior |
$23.46
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$107.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$10.01
|
| Rate for Payer: Heritage Provider Network Senior |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$58.40
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Senior |
$8.64
|
| Rate for Payer: TriValley Medical Group Senior |
$24.00
|
| Rate for Payer: TriValley Medical Group Senior |
$11.04
|
| Rate for Payer: TriValley Medical Group Senior |
$9.60
|
| Rate for Payer: TriValley Medical Group Senior |
$50.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.37
|
| Rate for Payer: Vantage Medical Group Senior |
$107.21
|
| Rate for Payer: Vantage Medical Group Senior |
$23.46
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.40
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$58.40
|
| Rate for Payer: Heritage Provider Network Senior |
$10.01
|
| Rate for Payer: Heritage Provider Network Senior |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.95
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.19
|
| Rate for Payer: Blue Shield of California EPN |
$3.19
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.11
|
| Rate for Payer: Heritage Provider Network Senior |
$11.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
901700004
|
|
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: Cash Price |
$0.60
|
| 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
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994-0810-64
|
| Hospital Charge Code |
901700004
|
|
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 |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.60
|
| 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 |
$0.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| 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: United Healthcare All Other HMO/non HMO |
$0.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Senior |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.23
|
| Rate for Payer: Heritage Provider Network Senior |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Senior |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.63
|
| Rate for Payer: Heritage Provider Network Senior |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-40
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.49
|
| Rate for Payer: Dignity Health Senior |
$7.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.45
|
| Rate for Payer: Heritage Provider Network Senior |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.17
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.52
|
| Rate for Payer: TriValley Medical Group Senior |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-21
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.49
|
| Rate for Payer: Dignity Health Senior |
$7.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.45
|
| Rate for Payer: Heritage Provider Network Senior |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.17
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.52
|
| Rate for Payer: TriValley Medical Group Senior |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.22
|
| Rate for Payer: Blue Shield of California EPN |
$2.58
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Senior |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Senior |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
