|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 0121135010
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
|
IP
|
$444.06
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$333.05 |
| Rate for Payer: Adventist Health Commercial |
$88.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.97
|
| Rate for Payer: Cash Price |
$199.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.60
|
| Rate for Payer: Heritage Provider Network Senior |
$205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.02
|
| Rate for Payer: Multiplan Commercial |
$333.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$160.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.03
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
|
OP
|
$444.06
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$1,870.58 |
| Rate for Payer: Adventist Health Commercial |
$88.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,371.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,247.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,119.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,434.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,434.12
|
| Rate for Payer: Cash Price |
$199.83
|
| Rate for Payer: Cash Price |
$199.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,558.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,247.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.60
|
| Rate for Payer: Heritage Provider Network Senior |
$205.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,247.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$211.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,434.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,671.05
|
| Rate for Payer: Multiplan Commercial |
$333.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$177.62
|
| Rate for Payer: TriValley Medical Group Senior |
$177.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$160.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,558.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.76
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.64
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2.89
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$14.31
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
|
OP
|
$19.25
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.39
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.91
|
| Rate for Payer: Heritage Provider Network Senior |
$8.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.47
|
| Rate for Payer: Multiplan Commercial |
$14.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.70
|
| Rate for Payer: TriValley Medical Group Senior |
$7.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.36
|
| Rate for Payer: Vantage Medical Group Senior |
$16.36
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
|
IP
|
$19.25
|
|
|
Service Code
|
HCPCS J3374
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.40
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.91
|
| Rate for Payer: Heritage Provider Network Senior |
$8.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.37
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.31
|
| Rate for Payer: Blue Shield of California EPN |
$3.51
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$14.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$2.50
|
| Rate for Payer: TriValley Medical Group Senior |
$7.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.22
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$16.22
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
|
OP
|
$260.68
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$221.58 |
| Rate for Payer: Adventist Health Commercial |
$52.14
|
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$159.01
|
| Rate for Payer: Blue Shield of California Commercial |
$155.55
|
| Rate for Payer: Blue Shield of California Commercial |
$40.26
|
| Rate for Payer: Blue Shield of California EPN |
$127.21
|
| Rate for Payer: Blue Shield of California EPN |
$32.21
|
| Rate for Payer: Blue Shield of California EPN |
$124.44
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.56
|
| Rate for Payer: Heritage Provider Network Senior |
$120.69
|
| Rate for Payer: Heritage Provider Network Senior |
$118.06
|
| Rate for Payer: Heritage Provider Network Senior |
$30.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$124.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$182.48
|
| Rate for Payer: Multiplan Commercial |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$104.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Senior |
$26.40
|
| Rate for Payer: TriValley Medical Group Senior |
$104.27
|
| Rate for Payer: TriValley Medical Group Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$84.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.58
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$56.10
|
| Rate for Payer: Vantage Medical Group Senior |
$221.58
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Adventist Health Commercial |
$52.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.22
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.69
|
| Rate for Payer: Heritage Provider Network Senior |
$120.69
|
| Rate for Payer: Heritage Provider Network Senior |
$118.06
|
| Rate for Payer: Heritage Provider Network Senior |
$30.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$195.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$84.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.31
|
|
|
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 |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| 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 |
$0.16
|
| 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| 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 Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| 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 Foundation Hospitals 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 |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| 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 |
$0.16
|
| 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| 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 Non-Gatekeeper |
$5.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| 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 |
$7.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| 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 |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| 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 |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| 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/Medicare |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.88
|
| 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 |
$3.36
|
| Rate for Payer: TriValley Medical Group Senior |
$3.92
|
| 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+ |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| 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/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
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: Aetna of CA Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.30
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.41
|
| 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 |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| 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 Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.77
|
| 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 |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
OP
|
$6.51
|
|
|
Service Code
|
NDC 0409653401
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.53
|
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.02
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3.26
|
| 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 |
$2.93
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Senior |
$5.53
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
|
IP
|
$6.51
|
|
|
Service Code
|
NDC 0409653401
|
| 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: Aetna of CA Non-Gatekeeper |
$4.19
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 Foundation Hospitals 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 INTRAVENOUS SOLUTION [8443]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.08
|
| 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 |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.34
|
| 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 |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2.93
|
| Rate for Payer: Blue Shield of California EPN |
$2.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.73
|
| 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 |
$4.10
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.27
|
| 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 |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.64
|
| 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 |
$2.22
|
| 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 Foundation Hospitals Commercial |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.85
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| 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 |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.92
|
| 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 |
$3.36
|
| Rate for Payer: TriValley Medical Group Senior |
$1.92
|
| Rate for Payer: TriValley Medical Group Senior |
$3.92
|
| 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 All Other HMO/non HMO |
$1.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.59
|
| 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+ |
$1.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.08
|
| 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 Commercial/Exchange |
$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 Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.01
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.08
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.71
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$0.96
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.09
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| 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 |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| 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 |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.64
|
| 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 |
$2.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2.22
|
| 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: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| 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 |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.65
|
| 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 All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.73
|
| 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+ |
$1.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.17
|
| 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 |
$0.16 |
| 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 Non-Gatekeeper |
$5.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| 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 |
$7.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.10
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| 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 |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.32
|
| 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 |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| 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/Medicare |
$6.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.88
|
| 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 |
$3.36
|
| Rate for Payer: TriValley Medical Group Senior |
$3.92
|
| 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+ |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
| 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 (NO TROUGH GOAL) [4081893]
|
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: Aetna of CA Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.30
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.41
|
| 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 |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| 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 Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.77
|
| 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 |
$3.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.78
|
|
|
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: Aetna of CA Non-Gatekeeper |
$6.21
|
| Rate for Payer: Cash Price |
$4.34
|
| 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 Foundation Hospitals 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 |
$0.16 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.96
|
| 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 |
$0.16
|
| 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 |
$4.34
|
| Rate for Payer: Cash Price |
$4.34
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$59.99
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| 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 Non-Gatekeeper |
$18.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.07
|
| 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 |
$32.99
|
| 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 Medicare Advantage/Dual Product |
$44.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$36.59
|
| 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 EPN |
$29.28
|
| Rate for Payer: Blue Shield of California EPN |
$46.56
|
| Rate for Payer: Blue Shield of California EPN |
$14.27
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.17
|
| 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 Foundation Hospitals Commercial |
$45.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.99
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.16
|
| 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 |
$34.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.09
|
| 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 Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
| Rate for Payer: Vantage Medical Group Senior |
$81.09
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.83
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.39
|
| 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 Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| 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
|
|
