|
VILAZODONE 20 MG TABLET [109403]
|
Facility
IP
|
$6.13
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
1712642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Blue Shield of California Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
|
|
VILAZODONE 20 MG TABLET [109403]
|
Facility
OP
|
$6.13
|
|
|
Service Code
|
NDC 60505-4773-3
|
| Hospital Charge Code |
1712642
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.65
|
| Rate for Payer: BCBS Transplant Transplant |
$3.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4.52
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cigna of CA HMO |
$4.29
|
| Rate for Payer: Cigna of CA PPO |
$4.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.21
|
| Rate for Payer: Dignity Health Media |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.45
|
| Rate for Payer: Galaxy Health WC |
$5.21
|
| Rate for Payer: Global Benefits Group Commercial |
$3.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.47
|
| Rate for Payer: Multiplan Commercial |
$4.90
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$5.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.06
|
| Rate for Payer: United Healthcare All Other HMO |
$3.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$5.21
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
IP
|
$5.66
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
NDG8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Blue Shield of California EPN |
$2.90
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION [8594]
|
Facility
OP
|
$5.66
|
|
|
Service Code
|
CPT J9360
|
| Hospital Charge Code |
NDG8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.57
|
| Rate for Payer: BCBS Transplant Transplant |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
IP
|
$19.37
|
|
|
Service Code
|
NDC 61703-309-06
|
| Hospital Charge Code |
1755769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Blue Shield of California Commercial |
$13.79
|
| Rate for Payer: Blue Shield of California EPN |
$9.92
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION [8597]
|
Facility
OP
|
$19.37
|
|
|
Service Code
|
NDC 61703-309-06
|
| Hospital Charge Code |
1755769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.54
|
| Rate for Payer: BCBS Transplant Transplant |
$11.62
|
| Rate for Payer: Blue Shield of California Commercial |
$14.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.31
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna of CA HMO |
$13.56
|
| Rate for Payer: Cigna of CA PPO |
$13.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.46
|
| Rate for Payer: Dignity Health Media |
$16.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
IP
|
$8.39
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
1755094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.30
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION [120009]
|
Facility
OP
|
$8.39
|
|
|
Service Code
|
CPT J9370
|
| Hospital Charge Code |
1755094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$71.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.29
|
| Rate for Payer: BCBS Transplant Transplant |
$5.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cigna of CA HMO |
$5.87
|
| Rate for Payer: Cigna of CA PPO |
$5.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.13
|
| Rate for Payer: Dignity Health Media |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.36
|
| Rate for Payer: Galaxy Health WC |
$7.13
|
| Rate for Payer: Global Benefits Group Commercial |
$5.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7.13
|
|
|
VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]
|
Facility
IP
|
$20,636.03
|
|
|
Service Code
|
NDC 72893-008-03
|
| Hospital Charge Code |
ERX201456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,952.65 |
| Max. Negotiated Rate |
$17,540.63 |
| Rate for Payer: Blue Shield of California Commercial |
$14,692.85
|
| Rate for Payer: Blue Shield of California EPN |
$10,565.65
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Cigna of CA HMO |
$14,445.22
|
| Rate for Payer: Cigna of CA PPO |
$14,445.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,254.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,254.41
|
| Rate for Payer: Galaxy Health WC |
$17,540.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12,381.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,764.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,862.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,952.65
|
| Rate for Payer: Multiplan Commercial |
$16,508.82
|
| Rate for Payer: Networks By Design Commercial |
$10,318.02
|
| Rate for Payer: Prime Health Services Commercial |
$17,540.63
|
|
|
VINCRISTINE SULFATE LIPOSOMAL 5 MG/31 ML(0.16 MG/ML)(FINAL CONC)IV KIT [201456]
|
Facility
OP
|
$20,636.03
|
|
|
Service Code
|
NDC 72893-008-03
|
| Hospital Charge Code |
ERX201456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,952.65 |
| Max. Negotiated Rate |
$17,540.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,535.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,540.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,349.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,349.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,294.95
|
| Rate for Payer: BCBS Transplant Transplant |
$12,381.62
|
| Rate for Payer: Blue Shield of California Commercial |
$15,208.75
|
| Rate for Payer: Blue Shield of California EPN |
$12,051.44
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Cash Price |
$9,286.21
|
| Rate for Payer: Cigna of CA HMO |
$14,445.22
|
| Rate for Payer: Cigna of CA PPO |
$14,445.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,540.63
|
| Rate for Payer: Dignity Health Media |
$17,540.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,540.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,254.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,254.41
|
| Rate for Payer: Galaxy Health WC |
$17,540.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12,381.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15,477.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,764.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,862.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,952.65
|
| Rate for Payer: Multiplan Commercial |
$16,508.82
|
| Rate for Payer: Networks By Design Commercial |
$10,318.02
|
| Rate for Payer: Prime Health Services Commercial |
$17,540.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,381.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,381.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,318.02
|
| Rate for Payer: United Healthcare All Other HMO |
$10,318.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,318.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,318.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,540.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,540.63
|
| Rate for Payer: Vantage Medical Group Senior |
$17,540.63
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
NDG14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Blue Shield of California Commercial |
$21.36
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION [14203]
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
NDG14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$203.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.22
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.11
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$21.00
|
| Rate for Payer: Cigna of CA PPO |
$21.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Media |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$15.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
IP
|
$21.60
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
1755671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California Commercial |
$14.52
|
| Rate for Payer: Blue Shield of California EPN |
$11.06
|
| Rate for Payer: Blue Shield of California EPN |
$10.44
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.41
|
| 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: Kaiser Permanente of CA Medi-Cal |
$8.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]
|
Facility
OP
|
$20.40
|
|
|
Service Code
|
CPT J9390
|
| Hospital Charge Code |
1755671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$203.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.36
|
| 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 Medi-Cal |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.22
|
| Rate for Payer: BCBS Transplant Transplant |
$12.96
|
| Rate for Payer: BCBS Transplant Transplant |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$15.92
|
| Rate for Payer: Blue Shield of California Commercial |
$15.03
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: Cigna of CA HMO |
$15.12
|
| Rate for Payer: Cigna of CA HMO |
$14.28
|
| Rate for Payer: Cigna of CA PPO |
$15.12
|
| Rate for Payer: Cigna of CA PPO |
$14.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.34
|
| Rate for Payer: Dignity Health Media |
$17.34
|
| Rate for Payer: Dignity Health Media |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.16
|
| Rate for Payer: Galaxy Health WC |
$18.36
|
| Rate for Payer: Galaxy Health WC |
$17.34
|
| Rate for Payer: Global Benefits Group Commercial |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$12.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.20
|
| 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 Commercial/Self Funded |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$17.28
|
| Rate for Payer: Networks By Design Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$17.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.80
|
| 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 All Other HMO |
$10.80
|
| Rate for Payer: United Healthcare HMO Rider |
$10.80
|
| Rate for Payer: United Healthcare HMO Rider |
$10.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.36
|
| 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 Medi-Cal |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$18.36
|
| Rate for Payer: Vantage Medical Group Senior |
$17.34
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$8,138.40
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$6,243.01 |
| Max. Negotiated Rate |
$8,138.40 |
| Rate for Payer: IEHP Medi-Cal |
$6,243.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,138.40
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$12,213.83
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$9,369.29 |
| Max. Negotiated Rate |
$12,213.83 |
| Rate for Payer: IEHP Medi-Cal |
$9,369.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,213.83
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$5,705.22
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$4,376.51 |
| Max. Negotiated Rate |
$5,705.22 |
| Rate for Payer: IEHP Medi-Cal |
$4,376.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,705.22
|
|
|
VIRAL ILLNESS
|
Facility
IP
|
$24,126.14
|
|
|
Service Code
|
APR-DRG 7234
|
| Min. Negotiated Rate |
$18,507.29 |
| Max. Negotiated Rate |
$24,126.14 |
| Rate for Payer: IEHP Medi-Cal |
$18,507.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,126.14
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$37,038.71
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$28,412.59 |
| Max. Negotiated Rate |
$37,038.71 |
| Rate for Payer: IEHP Medi-Cal |
$28,412.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37,038.71
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$18,626.65
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$14,288.60 |
| Max. Negotiated Rate |
$18,626.65 |
| Rate for Payer: IEHP Medi-Cal |
$14,288.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,626.65
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$7,441.44
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$5,708.37 |
| Max. Negotiated Rate |
$7,441.44 |
| Rate for Payer: IEHP Medi-Cal |
$5,708.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,441.44
|
|
|
VIRAL MENINGITIS
|
Facility
IP
|
$11,206.48
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$8,596.55 |
| Max. Negotiated Rate |
$11,206.48 |
| Rate for Payer: IEHP Medi-Cal |
$8,596.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,206.48
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
IP
|
$0.05
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
OP
|
$0.02
|
|
|
Service Code
|
NDC 0761-0433-10
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: BCBS Transplant Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Media |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.02
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Vantage Medical Group Senior |
$0.02
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [8639]
|
Facility
OP
|
$0.05
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
1712644
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.03
|
| Rate for Payer: BCBS Transplant Transplant |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.04
|
| Rate for Payer: Dignity Health Media |
$0.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.04
|
| Rate for Payer: Global Benefits Group Commercial |
$0.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.04
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.04
|
|
