|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.01
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Senior |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.16
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.91
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.85
|
| 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 |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.91
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.26
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Senior |
$4.72
|
| Rate for Payer: TriValley Medical Group Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$10.03
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994081576
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.51
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.53
|
| Rate for Payer: Heritage Provider Network Senior |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 9994081576
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.39
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
OP
|
$232.56
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$141.86
|
| Rate for Payer: Blue Shield of California EPN |
$113.49
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.68
|
| Rate for Payer: Heritage Provider Network Senior |
$107.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$110.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.79
|
| Rate for Payer: Multiplan Commercial |
$174.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$93.02
|
| Rate for Payer: TriValley Medical Group Senior |
$93.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.68
|
| Rate for Payer: Vantage Medical Group Senior |
$197.68
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
|
IP
|
$232.56
|
|
|
Service Code
|
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: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.68
|
| Rate for Payer: Heritage Provider Network Senior |
$107.68
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 9994080446
|
| 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 Non-Gatekeeper |
$0.64
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| 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 |
$0.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 9994080446
|
| 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: Aetna of CA Non-Gatekeeper |
$0.66
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
OP
|
$229.64
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Adventist Health Commercial |
$45.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$141.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.58
|
| 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 |
$103.34
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.32
|
| Rate for Payer: Heritage Provider Network Senior |
$106.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$109.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$160.75
|
| Rate for Payer: Multiplan Commercial |
$172.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$91.86
|
| Rate for Payer: TriValley Medical Group Senior |
$91.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.19
|
| Rate for Payer: Vantage Medical Group Senior |
$195.19
|
|
|
VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP [14757]
|
Facility
|
IP
|
$229.64
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$172.23 |
| Rate for Payer: Adventist Health Commercial |
$45.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.89
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.32
|
| Rate for Payer: Heritage Provider Network Senior |
$106.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$172.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.03
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
OP
|
$281.63
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.98 |
| Max. Negotiated Rate |
$346.16 |
| Rate for Payer: Adventist Health Commercial |
$56.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.16
|
| 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 |
$126.73
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.39
|
| Rate for Payer: Heritage Provider Network Senior |
$130.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$134.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.14
|
| Rate for Payer: Multiplan Commercial |
$211.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$112.65
|
| Rate for Payer: TriValley Medical Group Senior |
$112.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.39
|
| Rate for Payer: Vantage Medical Group Senior |
$239.39
|
|
|
VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION [219986]
|
Facility
|
IP
|
$281.63
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.98 |
| Max. Negotiated Rate |
$211.22 |
| Rate for Payer: Adventist Health Commercial |
$56.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.37
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$129.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.39
|
| Rate for Payer: Heritage Provider Network Senior |
$130.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.41
|
| Rate for Payer: Multiplan Commercial |
$211.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$101.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$93.25
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,688.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Senior |
$3,306.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,108.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,957.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2,957.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| 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 Medi-Cal |
$8.51
|
| 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 |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| 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 |
$56.76
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$10.01
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$7.17
|
| Rate for Payer: Heritage Provider Network Senior |
$58.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.00
|
| 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: LLUH Dept of Risk Management WC |
$3.87
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$88.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Senior |
$50.45
|
| Rate for Payer: TriValley Medical Group Senior |
$6.19
|
| Rate for Payer: TriValley Medical Group Senior |
$11.04
|
| Rate for Payer: TriValley Medical Group Senior |
$8.64
|
| Rate for Payer: TriValley Medical Group Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.57
|
| 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 Navigate/Select/Select+ |
$9.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.13
|
| 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 |
$13.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| 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 Medi-Cal |
$107.21
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
| 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 |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [207969]
|
Facility
|
IP
|
$126.13
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.83 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Adventist Health Commercial |
$25.23
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.92
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$56.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| 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 |
$7.17
|
| Rate for Payer: Heritage Provider Network Senior |
$10.01
|
| Rate for Payer: Heritage Provider Network Senior |
$58.40
|
| Rate for Payer: Heritage Provider Network Senior |
$7.17
|
| Rate for Payer: Heritage Provider Network Senior |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| 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: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.53
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$16.21
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: Multiplan Commercial |
$94.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| 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 |
$9.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.13
|
| 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
|
$15.48
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.97
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.17
|
| Rate for Payer: Heritage Provider Network Senior |
$7.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.13
|
|
|
VASOPRESSIN 20 UNITS/ML 1 ML VIAL - CODE [4080573]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| 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 |
$6.97
|
| Rate for Payer: Cash Price |
$6.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.17
|
| Rate for Payer: Heritage Provider Network Senior |
$7.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.84
|
| Rate for Payer: Multiplan Commercial |
$11.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.19
|
| Rate for Payer: TriValley Medical Group Senior |
$6.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.16
|
| Rate for Payer: Vantage Medical Group Senior |
$13.16
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 9994081064
|
| 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 Non-Gatekeeper |
$0.67
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| 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 |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
VASOPRESSIN SPEC DIL 2 UNITS/ML [4081064]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 9994081064
|
| 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: Aetna of CA Non-Gatekeeper |
$0.70
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.61
|
| 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: 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 Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$4.98
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.72
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.74
|
| Rate for Payer: TriValley Medical Group Senior |
$4.08
|
| Rate for Payer: TriValley Medical Group Senior |
$2.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.81
|
| 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 Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.40
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$3.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$5.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.38
|
|
