|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [152936]
|
Facility
OP
|
$0.34
|
|
|
Service Code
|
NDC 0121-4675-40
|
| Hospital Charge Code |
1716069
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Senior |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 0121-0675-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 60432-621-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
OP
|
$0.03
|
|
|
Service Code
|
NDC 60432-621-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Senior |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [8428]
|
Facility
IP
|
$0.03
|
|
|
Service Code
|
NDC 0121-0675-16
|
| Hospital Charge Code |
NDG8428
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.02
|
| Rate for Payer: Heritage Provider Network Senior |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-56
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 0121-1350-10
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Senior |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
IP
|
$0.15
|
|
|
Service Code
|
NDC 68094-701-61
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| 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: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 0121-1350-10
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-56
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
OP
|
$0.15
|
|
|
Service Code
|
NDC 68094-701-61
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.13
|
| Rate for Payer: Dignity Health Senior |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Vantage Medical Group Senior |
$0.13
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-42
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VALPROIC ACID (AS SODIUM SALT) 500 MG/10 ML (10 ML) ORAL SOLUTION [188966]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
NDC 60687-262-42
|
| Hospital Charge Code |
NDG186966
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
IP
|
$508.13
|
|
|
Service Code
|
CPT J9357
|
| Hospital Charge Code |
NDG24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.97 |
| Max. Negotiated Rate |
$381.10 |
| Rate for Payer: Adventist Health Commercial |
$101.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.09
|
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.00
|
| Rate for Payer: Heritage Provider Network Senior |
$344.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.03
|
| Rate for Payer: Multiplan Commercial |
$381.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$185.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$169.77
|
|
|
VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION [24425]
|
Facility
OP
|
$508.13
|
|
|
Service Code
|
CPT J9357
|
| Hospital Charge Code |
NDG24425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.97 |
| Max. Negotiated Rate |
$2,686.11 |
| Rate for Payer: Adventist Health Commercial |
$101.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,686.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,704.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,500.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,500.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$987.34
|
| 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 |
$228.66
|
| Rate for Payer: Cash Price |
$228.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,045.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,500.23
|
| Rate for Payer: Dignity Health Senior |
$1,500.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,363.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.26
|
| Rate for Payer: Heritage Provider Network Senior |
$235.26
|
| Rate for Payer: Humana Medicare |
$1,363.85
|
| Rate for Payer: IEHP Medicare Advantage |
$1,363.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,591.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,609.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,718.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,718.45
|
| Rate for Payer: Multiplan Commercial |
$381.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,500.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,363.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$185.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$169.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,045.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,500.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,363.85
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
IP
|
$19.08
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1717199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$14.31 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.22
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.03
|
| Rate for Payer: Heritage Provider Network Senior |
$13.03
|
| Rate for Payer: Heritage Provider Network Senior |
$12.92
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$14.31
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.43
|
|
|
VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION [8442]
|
Facility
OP
|
$19.08
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1717199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$3.82
|
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.22
|
| Rate for Payer: Dignity Health Senior |
$16.22
|
| Rate for Payer: Dignity Health Senior |
$16.36
|
| Rate for Payer: Dignity Health Senior |
$6.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.91
|
| Rate for Payer: Heritage Provider Network Senior |
$8.83
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$8.91
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$14.44
|
| Rate for Payer: Multiplan Commercial |
$14.31
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.22
|
| Rate for Payer: Vantage Medical Group Senior |
$16.36
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.22
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
IP
|
$260.68
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.18 |
| Max. Negotiated Rate |
$195.51 |
| Rate for Payer: Adventist Health Commercial |
$52.14
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.09
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| 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 |
$51.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.48
|
| Rate for Payer: Heritage Provider Network Senior |
$176.48
|
| Rate for Payer: Heritage Provider Network Senior |
$172.64
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.07
|
|
|
VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION [11627]
|
Facility
OP
|
$260.68
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX11627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.67 |
| 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 |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$117.31
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$221.58
|
| Rate for Payer: Dignity Health Senior |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.45
|
| 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 |
$44.45
|
| Rate for Payer: Heritage Provider Network Senior |
$120.69
|
| Rate for Payer: Heritage Provider Network Senior |
$118.06
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$125.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$195.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$32.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$221.58
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$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 Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: 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
|
| 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
|
CPT J3370
|
| Hospital Charge Code |
NDG2226
|
|
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 |
$0.11
|
| 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 |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$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 Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: 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
|
| 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
|
CPT J3370
|
| Hospital Charge Code |
1753176
|
|
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 |
$0.11
|
| 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 |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
IP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2227
|
|
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 |
$0.11
|
| 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 |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.05
|
|
|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [92895]
|
Facility
OP
|
$0.16
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG2226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$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 Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
