|
VALACYCLOVIR ORAL SUSPENSION COMPOUND 50 MG/ML [4080355]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 9994-0803-55
|
| Hospital Charge Code |
1715245
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 27241-158-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 65862-753-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Blue Distinction Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Media |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-95
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.39
|
| Rate for Payer: Blue Distinction Transplant |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$37.59
|
| Rate for Payer: Blue Shield of California EPN |
$29.78
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Media |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$38.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$90.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.20
|
| Rate for Payer: Blue Distinction Transplant |
$63.65
|
| Rate for Payer: Blue Shield of California Commercial |
$78.18
|
| Rate for Payer: Blue Shield of California EPN |
$61.95
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: Cigna of CA HMO |
$67.89
|
| Rate for Payer: Cigna of CA PPO |
$78.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.17
|
| Rate for Payer: Dignity Health Media |
$90.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$90.17
|
| Rate for Payer: Global Benefits Group Commercial |
$63.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$79.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.46
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Networks By Design Commercial |
$68.95
|
| Rate for Payer: Prime Health Services Commercial |
$90.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.04
|
| Rate for Payer: United Healthcare All Other HMO |
$53.04
|
| Rate for Payer: United Healthcare HMO Rider |
$53.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.17
|
| Rate for Payer: Vantage Medical Group Senior |
$90.17
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$20.19
|
|
|
Service Code
|
NDC 0603-6330-20
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Blue Shield of California Commercial |
$14.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.34
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$16.15
|
| Rate for Payer: Networks By Design Commercial |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$17.16
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$28.11
|
|
|
Service Code
|
NDC 55111-762-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.75
|
| Rate for Payer: Blue Distinction Transplant |
$16.87
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California EPN |
$16.42
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: Cigna of CA HMO |
$17.99
|
| Rate for Payer: Cigna of CA PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.89
|
| Rate for Payer: Dignity Health Media |
$23.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.24
|
| Rate for Payer: Galaxy Health WC |
$23.89
|
| Rate for Payer: Global Benefits Group Commercial |
$16.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$22.49
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$23.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.06
|
| Rate for Payer: United Healthcare All Other HMO |
$14.06
|
| Rate for Payer: United Healthcare HMO Rider |
$14.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.89
|
| Rate for Payer: Vantage Medical Group Senior |
$23.89
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 69097-277-03
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California EPN |
$3.07
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 31722-832-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: Blue Distinction Transplant |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.10
|
| Rate for Payer: Dignity Health Media |
$5.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5.10
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-25
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.39
|
| Rate for Payer: Blue Distinction Transplant |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$37.59
|
| Rate for Payer: Blue Shield of California EPN |
$29.78
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Media |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$38.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 27241-158-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.98
|
| Rate for Payer: Blue Distinction Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.68
|
| Rate for Payer: Blue Shield of California EPN |
$2.92
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Media |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-25
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Blue Shield of California Commercial |
$36.31
|
| Rate for Payer: Blue Shield of California EPN |
$26.11
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 65862-753-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Blue Shield of California Commercial |
$3.39
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 69097-277-03
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Blue Distinction Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.51
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Media |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
OP
|
$20.19
|
|
|
Service Code
|
NDC 0603-6330-20
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.03
|
| Rate for Payer: Blue Distinction Transplant |
$12.11
|
| Rate for Payer: Blue Shield of California Commercial |
$14.88
|
| Rate for Payer: Blue Shield of California EPN |
$11.79
|
| Rate for Payer: Cash Price |
$9.09
|
| Rate for Payer: Cigna of CA HMO |
$12.92
|
| Rate for Payer: Cigna of CA PPO |
$14.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.16
|
| Rate for Payer: Dignity Health Media |
$17.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$17.16
|
| Rate for Payer: Global Benefits Group Commercial |
$12.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$16.15
|
| Rate for Payer: Networks By Design Commercial |
$13.12
|
| Rate for Payer: Prime Health Services Commercial |
$17.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO |
$10.10
|
| Rate for Payer: United Healthcare HMO Rider |
$10.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Vantage Medical Group Senior |
$17.16
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$28.11
|
|
|
Service Code
|
NDC 55111-762-60
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Blue Shield of California Commercial |
$20.01
|
| Rate for Payer: Blue Shield of California EPN |
$14.39
|
| Rate for Payer: Cash Price |
$12.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.24
|
| Rate for Payer: Galaxy Health WC |
$23.89
|
| Rate for Payer: Global Benefits Group Commercial |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$22.49
|
| Rate for Payer: Networks By Design Commercial |
$18.27
|
| Rate for Payer: Prime Health Services Commercial |
$23.89
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$90.17 |
| Rate for Payer: Blue Shield of California Commercial |
$75.53
|
| Rate for Payer: Blue Shield of California EPN |
$54.31
|
| Rate for Payer: Cash Price |
$47.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$90.17
|
| Rate for Payer: Global Benefits Group Commercial |
$63.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.46
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Networks By Design Commercial |
$68.95
|
| Rate for Payer: Prime Health Services Commercial |
$90.17
|
|
|
VALGANCICLOVIR 450 MG TABLET [30148]
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
NDC 68084-965-95
|
| Hospital Charge Code |
1712248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Blue Shield of California Commercial |
$36.31
|
| Rate for Payer: Blue Shield of California EPN |
$26.11
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]
|
Facility
|
OP
|
$10.91
|
|
|
Service Code
|
NDC 70010-051-40
|
| Hospital Charge Code |
1715257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$7.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.27
|
| Rate for Payer: Dignity Health Media |
$9.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other HMO |
$5.46
|
| Rate for Payer: United Healthcare HMO Rider |
$5.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.27
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]
|
Facility
|
IP
|
$10.91
|
|
|
Service Code
|
NDC 70010-051-40
|
| Hospital Charge Code |
1715257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Blue Shield of California Commercial |
$7.77
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$7.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]
|
Facility
|
OP
|
$10.91
|
|
|
Service Code
|
NDC 0591-2579-20
|
| Hospital Charge Code |
1715257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.37
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$7.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.27
|
| Rate for Payer: Dignity Health Media |
$9.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.46
|
| Rate for Payer: United Healthcare All Other HMO |
$5.46
|
| Rate for Payer: United Healthcare HMO Rider |
$5.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.27
|
|
|
VALGANCICLOVIR 50 MG/ML ORAL SOLUTION [99443]
|
Facility
|
IP
|
$10.91
|
|
|
Service Code
|
NDC 0591-2579-20
|
| Hospital Charge Code |
1715257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Blue Shield of California Commercial |
$7.77
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cigna of CA HMO |
$7.64
|
| Rate for Payer: Cigna of CA PPO |
$7.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: Galaxy Health WC |
$9.27
|
| Rate for Payer: Global Benefits Group Commercial |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.09
|
| Rate for Payer: Prime Health Services Commercial |
$9.27
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 63323-494-01
|
| Hospital Charge Code |
1721089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Galaxy Health WC |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.39
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.05
|
| Rate for Payer: Prime Health Services Commercial |
$1.37
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 0143-9785-10
|
| Hospital Charge Code |
1721089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Blue Distinction Transplant |
$2.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.42
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cigna of CA HMO |
$2.66
|
| Rate for Payer: Cigna of CA PPO |
$3.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.53
|
| Rate for Payer: Dignity Health Media |
$3.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.66
|
| Rate for Payer: Galaxy Health WC |
$3.53
|
| Rate for Payer: Global Benefits Group Commercial |
$2.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$3.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.08
|
| Rate for Payer: United Healthcare All Other HMO |
$2.08
|
| Rate for Payer: United Healthcare HMO Rider |
$2.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.53
|
| Rate for Payer: Vantage Medical Group Senior |
$3.53
|
|
