|
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 |
$4.90 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| 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 |
$11.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.15
|
| Rate for Payer: BCBS Transplant Transplant |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$15.03
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO |
$13.06
|
| Rate for Payer: Cigna of CA PPO |
$15.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Media |
$17.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$13.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO |
$10.20
|
| Rate for Payer: United Healthcare HMO Rider |
$10.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.34
|
| 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
|
$10.80
|
|
|
Service Code
|
NDC 55150-236-01
|
| Hospital Charge Code |
1720438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.53
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.32
|
| Rate for Payer: Galaxy Health WC |
$9.18
|
| Rate for Payer: Global Benefits Group Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$8.64
|
| Rate for Payer: Networks By Design Commercial |
$7.02
|
| Rate for Payer: Prime Health Services Commercial |
$9.18
|
|
|
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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| 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 |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| 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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| 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 |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| 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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| 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 |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| 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 41616-931-40
|
| Hospital Charge Code |
ERX4081284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.69
|
| 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 |
$5.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.08
|
| Rate for Payer: BCBS Transplant Transplant |
$6.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$6.53
|
| Rate for Payer: Cigna of CA PPO |
$7.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5.10
|
| Rate for Payer: United Healthcare HMO Rider |
$5.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| 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 |
$2.45 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.22
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.08
|
| Rate for Payer: Galaxy Health WC |
$8.67
|
| Rate for Payer: Global Benefits Group Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.16
|
| Rate for Payer: Networks By Design Commercial |
$6.63
|
| Rate for Payer: Prime Health Services Commercial |
$8.67
|
|
|
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 |
$2,354.69 |
| Max. Negotiated Rate |
$8,339.54 |
| Rate for Payer: Blue Shield of California Commercial |
$6,985.59
|
| Rate for Payer: Blue Shield of California EPN |
$5,023.34
|
| Rate for Payer: Cash Price |
$4,415.05
|
| Rate for Payer: Cigna of CA HMO |
$6,867.85
|
| Rate for Payer: Cigna of CA PPO |
$6,867.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,924.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,924.49
|
| Rate for Payer: Galaxy Health WC |
$8,339.54
|
| Rate for Payer: Global Benefits Group Commercial |
$5,886.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,544.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,738.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.69
|
| Rate for Payer: Multiplan Commercial |
$7,848.98
|
| Rate for Payer: Networks By Design Commercial |
$4,905.61
|
| Rate for Payer: Prime Health Services Commercial |
$8,339.54
|
|
|
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 |
$8,339.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.74
|
| 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 |
$34.26
|
| Rate for Payer: BCBS Transplant Transplant |
$5,886.73
|
| Rate for Payer: Blue Shield of California Commercial |
$7,230.87
|
| Rate for Payer: Blue Shield of California EPN |
$27.99
|
| Rate for Payer: Cash Price |
$4,415.05
|
| Rate for Payer: Cash Price |
$4,415.05
|
| Rate for Payer: Cigna of CA HMO |
$6,867.85
|
| Rate for Payer: Cigna of CA PPO |
$6,867.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.09
|
| Rate for Payer: Dignity Health Media |
$22.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.06
|
| Rate for Payer: Galaxy Health WC |
$8,339.54
|
| Rate for Payer: Global Benefits Group Commercial |
$5,886.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,358.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$36.18
|
| Rate for Payer: IEHP Medi-Cal |
$35.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35.74
|
| Rate for Payer: IEHP Medicare Advantage |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,544.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.56
|
| Rate for Payer: Multiplan Commercial |
$7,848.98
|
| Rate for Payer: Networks By Design Commercial |
$4,905.61
|
| Rate for Payer: Prime Health Services Commercial |
$8,339.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,886.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,886.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,905.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,905.61
|
| Rate for Payer: United Healthcare HMO Rider |
$4,905.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,905.61
|
| 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 |
$35.51 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Blue Shield of California Commercial |
$105.33
|
| Rate for Payer: Blue Shield of California EPN |
$75.75
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: Cigna of CA HMO |
$103.56
|
| Rate for Payer: Cigna of CA PPO |
$103.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.18
|
| Rate for Payer: Galaxy Health WC |
$125.75
|
| Rate for Payer: Global Benefits Group Commercial |
$88.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.51
|
| Rate for Payer: Multiplan Commercial |
$118.35
|
| Rate for Payer: Networks By Design Commercial |
$96.16
|
| Rate for Payer: Prime Health Services Commercial |
$125.75
|
|
|
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 |
$35.51 |
| Max. Negotiated Rate |
$125.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.03
|
| 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 |
$81.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.14
|
| Rate for Payer: BCBS Transplant Transplant |
$88.76
|
| Rate for Payer: Blue Shield of California Commercial |
$109.03
|
| Rate for Payer: Blue Shield of California EPN |
$86.40
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: Cigna of CA HMO |
$103.56
|
| Rate for Payer: Cigna of CA PPO |
$103.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.75
|
| Rate for Payer: Dignity Health Media |
$125.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.18
|
| Rate for Payer: Galaxy Health WC |
$125.75
|
| Rate for Payer: Global Benefits Group Commercial |
$88.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$110.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.51
|
| Rate for Payer: Multiplan Commercial |
$118.35
|
| Rate for Payer: Networks By Design Commercial |
$96.16
|
| Rate for Payer: Prime Health Services Commercial |
$125.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$88.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.97
|
| Rate for Payer: United Healthcare All Other HMO |
$73.97
|
| Rate for Payer: United Healthcare HMO Rider |
$73.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.75
|
| Rate for Payer: Vantage Medical Group Senior |
$125.75
|
|
|
VENLAFAXINE 100 MG TABLET [12205]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
NDC 68382-101-01
|
| Hospital Charge Code |
1712185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
|
|
VENLAFAXINE 100 MG TABLET [12205]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
NDC 68382-101-01
|
| Hospital Charge Code |
1712185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Media |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.30
|
| Rate for Payer: Prime Health Services Commercial |
$0.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
NDC 68084-896-95
|
| Hospital Charge Code |
1712239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
NDC 68084-896-25
|
| Hospital Charge Code |
1712239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: BCBS Transplant Transplant |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Media |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
OP
|
$1.26
|
|
|
Service Code
|
NDC 68084-896-95
|
| Hospital Charge Code |
1712239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.75
|
| Rate for Payer: BCBS Transplant Transplant |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.93
|
| Rate for Payer: Blue Shield of California EPN |
$0.74
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.07
|
| Rate for Payer: Dignity Health Media |
$1.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1.07
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
IP
|
$1.26
|
|
|
Service Code
|
NDC 68084-896-25
|
| Hospital Charge Code |
1712239
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Blue Shield of California Commercial |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO |
$0.88
|
| Rate for Payer: Cigna of CA PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.50
|
| Rate for Payer: Galaxy Health WC |
$1.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.01
|
| Rate for Payer: Networks By Design Commercial |
$0.82
|
| Rate for Payer: Prime Health Services Commercial |
$1.07
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
IP
|
$1.03
|
|
|
Service Code
|
NDC 68084-844-11
|
| Hospital Charge Code |
1712223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
IP
|
$0.40
|
|
|
Service Code
|
NDC 57664-393-88
|
| Hospital Charge Code |
1712223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
IP
|
$1.03
|
|
|
Service Code
|
NDC 68084-844-01
|
| Hospital Charge Code |
1712223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Blue Shield of California Commercial |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
OP
|
$0.40
|
|
|
Service Code
|
NDC 57664-393-88
|
| Hospital Charge Code |
1712223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.28
|
| Rate for Payer: Cigna of CA PPO |
$0.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.34
|
| Rate for Payer: Dignity Health Media |
$0.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.34
|
| Rate for Payer: Global Benefits Group Commercial |
$0.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.26
|
| Rate for Payer: Prime Health Services Commercial |
$0.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
VENLAFAXINE 37.5 MG TABLET [12207]
|
Facility
OP
|
$1.03
|
|
|
Service Code
|
NDC 68084-844-11
|
| Hospital Charge Code |
1712223
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: BCBS Transplant Transplant |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California EPN |
$0.60
|
| Rate for Payer: Cash Price |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.72
|
| Rate for Payer: Cigna of CA PPO |
$0.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Media |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Networks By Design Commercial |
$0.67
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
