|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM 10 MG IV BOLUS - CODE [4080584]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
ERX4080584
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$6.83
|
|
|
Service Code
|
NDC 63323-781-10
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.69
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$6.24
|
|
|
Service Code
|
NDC 63323-781-41
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.28
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.49
|
| Rate for Payer: Dignity Health Senior |
$4.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.27
|
| Rate for Payer: Heritage Provider Network Senior |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-40
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$6.24
|
|
|
Service Code
|
NDC 63323-781-44
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.47
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.49
|
| Rate for Payer: Dignity Health Senior |
$7.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.45
|
| Rate for Payer: Heritage Provider Network Senior |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Vantage Medical Group Senior |
$7.49
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-00
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$6.24
|
|
|
Service Code
|
NDC 63323-781-44
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.22
|
| Rate for Payer: Heritage Provider Network Senior |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 47335-931-44
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$6.83
|
|
|
Service Code
|
NDC 63323-781-10
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.01
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.81
|
| Rate for Payer: Dignity Health Senior |
$5.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.23
|
| Rate for Payer: Heritage Provider Network Senior |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Vantage Medical Group Senior |
$5.81
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-40
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-44
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: Dignity Health Senior |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.67
|
| Rate for Payer: Vantage Medical Group Senior |
$8.67
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$6.24
|
|
|
Service Code
|
NDC 63323-781-41
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.68
|
| Rate for Payer: Blue Shield of California Commercial |
$3.88
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$5.28
|
|
|
Service Code
|
NDC 55150-235-10
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Adventist Health Commercial |
$1.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.63
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$3.96
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$8.81
|
|
|
Service Code
|
NDC 0409-1632-01
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.05
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$6.61
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-00
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3.73
|
| Rate for Payer: Blue Shield of California EPN |
$3.52
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: Dignity Health Senior |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
NDC 67457-438-10
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.12
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.06
|
| Rate for Payer: Heritage Provider Network Senior |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-44
|
| Hospital Charge Code |
1720230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.01
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Senior |
$6.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.55
|
| Rate for Payer: Multiplan Commercial |
$7.65
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
OP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-20
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$12.29 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.84
|
| Rate for Payer: Blue Shield of California Commercial |
$8.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.49
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.29
|
| Rate for Payer: Dignity Health Senior |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.95
|
| Rate for Payer: Heritage Provider Network Senior |
$8.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$10.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.29
|
| Rate for Payer: Vantage Medical Group Senior |
$12.29
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
IP
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-01
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.31
|
| Rate for Payer: Heritage Provider Network Senior |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.10
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
NDC 67457-475-20
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
