|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
IP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-40
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.01
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.81
|
| Rate for Payer: Heritage Provider Network Senior |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
OP
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-20
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.18
|
| Rate for Payer: Dignity Health Senior |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.69
|
| Rate for Payer: Heritage Provider Network Senior |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.21
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.18
|
| Rate for Payer: Vantage Medical Group Senior |
$9.18
|
|
|
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
|
|
|
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
IP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-44
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.01
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.81
|
| Rate for Payer: Heritage Provider Network Senior |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
OP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-44
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$12.67
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: Dignity Health Senior |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.63
|
| Rate for Payer: Heritage Provider Network Senior |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
NDC 67457-475-00
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| 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
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
IP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-20
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.93
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.79
|
| Rate for Payer: Heritage Provider Network Senior |
$9.79
|
| 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
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
OP
|
$20.40
|
|
|
Service Code
|
NDC 47335-932-40
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$12.67
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: Dignity Health Senior |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.63
|
| Rate for Payer: Heritage Provider Network Senior |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.34
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
NDC 67457-475-00
|
| 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
|
|
|
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
OP
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-23
|
| 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
|
$14.46
|
|
|
Service Code
|
NDC 63323-782-23
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.93
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.79
|
| Rate for Payer: Heritage Provider Network Senior |
$9.79
|
| 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
|
|
|
VECURONIUM BROMIDE INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-44
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-44
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-40
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 0.5 MG/ML [4081455]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-40
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-40
|
| Hospital Charge Code |
ERX4081284
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-40
|
| Hospital Charge Code |
ERX4081284
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]
|
Facility
OP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-44
|
| Hospital Charge Code |
ERX4081284
|
|
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 INTRAVENOUS-NICU SPECIAL DILUTION 1MG/ML [4081284]
|
Facility
IP
|
$10.20
|
|
|
Service Code
|
NDC 41616-931-44
|
| Hospital Charge Code |
ERX4081284
|
|
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
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [205964]
|
Facility
IP
|
$9,811.22
|
|
|
Service Code
|
CPT J3380
|
| Hospital Charge Code |
ERX205964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,775.83 |
| Max. Negotiated Rate |
$7,358.42 |
| Rate for Payer: Adventist Health Commercial |
$1,962.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,740.31
|
| Rate for Payer: Cash Price |
$4,415.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,513.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,298.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,642.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6,642.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,452.80
|
| Rate for Payer: Multiplan Commercial |
$7,358.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,577.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,277.93
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [205964]
|
Facility
OP
|
$9,811.22
|
|
|
Service Code
|
CPT J3380
|
| Hospital Charge Code |
ERX205964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$7,358.42 |
| Rate for Payer: Adventist Health Commercial |
$1,962.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,740.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.35
|
| Rate for Payer: Blue Shield of California Commercial |
$26.22
|
| Rate for Payer: Blue Shield of California EPN |
$26.22
|
| Rate for Payer: Cash Price |
$4,415.05
|
| Rate for Payer: Cash Price |
$4,415.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,513.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.27
|
| Rate for Payer: Dignity Health Senior |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,279.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,542.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4,542.59
|
| Rate for Payer: Humana Medicare |
$22.06
|
| Rate for Payer: IEHP Medi-Cal |
$41.37
|
| Rate for Payer: IEHP Medicare Advantage |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,775.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,452.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$7,358.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.27
|
| Rate for Payer: TriValley Medical Group Senior |
$22.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,577.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,277.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.27
|
| Rate for Payer: Vantage Medical Group Senior |
$22.06
|
|
|
VENETOCLAX 100 MG TABLET [214191]
|
Facility
IP
|
$147.94
|
|
|
Service Code
|
NDC 0074-0576-22
|
| Hospital Charge Code |
ERX214191
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$110.96 |
| Rate for Payer: Adventist Health Commercial |
$29.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.63
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.16
|
| Rate for Payer: Heritage Provider Network Senior |
$100.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$110.96
|
|
|
VENETOCLAX 100 MG TABLET [214191]
|
Facility
OP
|
$147.94
|
|
|
Service Code
|
NDC 0074-0576-22
|
| Hospital Charge Code |
ERX214191
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Adventist Health Commercial |
$29.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$125.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$81.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.96
|
| Rate for Payer: Blue Shield of California Commercial |
$91.87
|
| Rate for Payer: Blue Shield of California EPN |
$86.84
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.75
|
| Rate for Payer: Dignity Health Senior |
$125.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.57
|
| Rate for Payer: Heritage Provider Network Senior |
$91.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$71.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$110.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.75
|
| Rate for Payer: Vantage Medical Group Senior |
$125.75
|
|
