|
VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK PER PHARMACY [40892895]
|
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 PER PHARMACY [40892895]
|
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 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
OP
|
$9.79
|
|
|
Service Code
|
NDC 0409-4332-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.06
|
| Rate for Payer: Heritage Provider Network Senior |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
OP
|
$8.40
|
|
|
Service Code
|
NDC 63323-221-10
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.93
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.20
|
| Rate for Payer: Heritage Provider Network Senior |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
OP
|
$6.51
|
|
|
Service Code
|
NDC 0409-6534-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.53
|
| Rate for Payer: Dignity Health Senior |
$5.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.03
|
| Rate for Payer: Heritage Provider Network Senior |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.53
|
| Rate for Payer: Vantage Medical Group Senior |
$5.53
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
IP
|
$9.79
|
|
|
Service Code
|
NDC 0409-4332-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
IP
|
$8.40
|
|
|
Service Code
|
NDC 63323-221-10
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
|
|
VANCOMYCIN 500 MG/5 ML MED NEB SOLUTION (IV FORM) [4088443]
|
Facility
IP
|
$6.51
|
|
|
Service Code
|
NDC 0409-6534-01
|
| Hospital Charge Code |
ERX4088443
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.47
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$4.88
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| 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 Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.24
|
| 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: 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 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: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$8.20
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| 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: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION [8443]
|
Facility
IP
|
$9.65
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
1720475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.63
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$6.63
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$6.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.27
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
OP
|
$8.40
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| 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 Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.34
|
| 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: 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 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: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$8.20
|
| Rate for Payer: Dignity Health Senior |
$8.32
|
| Rate for Payer: Dignity Health Senior |
$7.14
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| 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: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7.14
|
| Rate for Payer: Vantage Medical Group Senior |
$8.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
VANCOMYCIN 500 MG INTRAVENOUS SOLUTION (NO TROUGH GOAL) [4081893]
|
Facility
IP
|
$9.79
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4081893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Adventist Health Commercial |
$1.96
|
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Commercial |
$1.68
|
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.63
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.41
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6.53
|
| Rate for Payer: Heritage Provider Network Senior |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.27
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
IP
|
$29.24
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$21.93 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.21
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.80
|
| Rate for Payer: Heritage Provider Network Senior |
$64.59
|
| Rate for Payer: Heritage Provider Network Senior |
$19.80
|
| Rate for Payer: Heritage Provider Network Senior |
$40.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.04
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION [8444]
|
Facility
OP
|
$59.99
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$50.99 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Aetna of CA 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 |
$41.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$71.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.99
|
| 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 |
$42.93
|
| Rate for Payer: Cash Price |
$42.93
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.99
|
| Rate for Payer: Dignity Health Senior |
$24.85
|
| Rate for Payer: Dignity Health Senior |
$50.99
|
| Rate for Payer: Dignity Health Senior |
$81.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Senior |
$44.17
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| 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 |
$45.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$44.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.85
|
| Rate for Payer: Vantage Medical Group Senior |
$50.99
|
| Rate for Payer: Vantage Medical Group Senior |
$24.85
|
| Rate for Payer: Vantage Medical Group Senior |
$81.09
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
IP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
|
|
VANCOMYCIN 5 MG/ML SERIAL DILUTION FOR MIXTURES [4080888]
|
Facility
OP
|
$3.60
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX4080888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.70
|
| 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 |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Senior |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1.67
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| 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: 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 |
$0.05
|
| 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 Senior |
$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: IEHP Medi-Cal |
$10.56
|
| 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: 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 Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [108740]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG108740
|
|
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 |
$0.07
|
| 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 |
$0.07
|
| 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
|
| 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 INTRAVENOUS SOLUTION [97371]
|
Facility
IP
|
$8.02
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.51
|
| 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 |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA 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: Multiplan Commercial |
$8.85
|
| Rate for Payer: Multiplan Commercial |
$6.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.68
|
|
|
VANCOMYCIN 750 MG INTRAVENOUS SOLUTION [97371]
|
Facility
OP
|
$11.80
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
ERX97371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| 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 |
$5.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.41
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.85
|
| 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 EPN |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$5.31
|
| 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: Dignity Health Commercial/Exchange |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.82
|
| Rate for Payer: Dignity Health Senior |
$6.82
|
| Rate for Payer: Dignity Health Senior |
$10.03
|
| 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 |
$5.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.14
|
| 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 |
$6.02
|
| Rate for Payer: Multiplan Commercial |
$8.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$10.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
OP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
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 Gatekeeper |
$0.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Blue Shield of California Commercial |
$0.49
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Vantage Medical Group Senior |
$0.67
|
|
|
VANCOMYCIN/BSS 2MG/0.2ML SYRINGE [4081576]
|
Facility
IP
|
$0.79
|
|
|
Service Code
|
NDC 9994-0815-76
|
| Hospital Charge Code |
NDG4081576
|
|
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 |
$0.54
|
| 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 Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.59
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
OP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$197.68 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.68
|
| Rate for Payer: Dignity Health Senior |
$197.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.68
|
| Rate for Payer: Heritage Provider Network Senior |
$107.68
|
| Rate for Payer: IEHP Medi-Cal |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.14
|
| Rate for Payer: Multiplan Commercial |
$174.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.68
|
| Rate for Payer: Vantage Medical Group Senior |
$197.68
|
|
|
VANCOMYCIN (BULK) 900 MCG/MG (NOT LESS THAN) POWDER [12217]
|
Facility
IP
|
$232.56
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
NDG12217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Adventist Health Commercial |
$46.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.77
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.44
|
| Rate for Payer: Heritage Provider Network Senior |
$157.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.14
|
| Rate for Payer: Multiplan Commercial |
$174.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.70
|
|
|
VANCOMYCIN ORAL SOLUTION (IV FORM) 50 MG/ML [4080446]
|
Facility
OP
|
$1.03
|
|
|
Service Code
|
NDC 9994-0804-46
|
| Hospital Charge Code |
1715272
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.77
|
| Rate for Payer: Blue Shield of California Commercial |
$0.64
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: Dignity Health Senior |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Senior |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
