|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
IP
|
$2.60
|
|
|
Service Code
|
NDC 68462-572-30
|
| Hospital Charge Code |
1711819
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
|
|
VORICONAZOLE 50 MG TABLET [33008]
|
Facility
OP
|
$2.60
|
|
|
Service Code
|
NDC 68462-572-30
|
| Hospital Charge Code |
1711819
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.55
|
| Rate for Payer: BCBS Transplant Transplant |
$1.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.52
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.82
|
| Rate for Payer: Cigna of CA PPO |
$1.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.21
|
| Rate for Payer: Dignity Health Media |
$2.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.04
|
| Rate for Payer: Galaxy Health WC |
$2.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1.56
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.08
|
| Rate for Payer: Networks By Design Commercial |
$1.69
|
| Rate for Payer: Prime Health Services Commercial |
$2.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Vantage Medical Group Senior |
$2.21
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
IP
|
$150.10
|
|
|
Service Code
|
NDC 0006-0568-40
|
| Hospital Charge Code |
1711910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Blue Shield of California Commercial |
$106.87
|
| Rate for Payer: Blue Shield of California EPN |
$76.85
|
| Rate for Payer: Cash Price |
$67.55
|
| Rate for Payer: Cigna of CA HMO |
$105.07
|
| Rate for Payer: Cigna of CA PPO |
$105.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: Galaxy Health WC |
$127.58
|
| Rate for Payer: Global Benefits Group Commercial |
$90.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.02
|
| Rate for Payer: Multiplan Commercial |
$120.08
|
| Rate for Payer: Networks By Design Commercial |
$97.56
|
| Rate for Payer: Prime Health Services Commercial |
$127.58
|
|
|
VORINOSTAT 100 MG CAPSULE [77539]
|
Facility
OP
|
$150.10
|
|
|
Service Code
|
NDC 0006-0568-40
|
| Hospital Charge Code |
1711910
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$127.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$82.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$82.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.43
|
| Rate for Payer: BCBS Transplant Transplant |
$90.06
|
| Rate for Payer: Blue Shield of California Commercial |
$110.62
|
| Rate for Payer: Blue Shield of California EPN |
$87.66
|
| Rate for Payer: Cash Price |
$67.55
|
| Rate for Payer: Cigna of CA HMO |
$105.07
|
| Rate for Payer: Cigna of CA PPO |
$105.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.58
|
| Rate for Payer: Dignity Health Media |
$127.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.04
|
| Rate for Payer: Galaxy Health WC |
$127.58
|
| Rate for Payer: Global Benefits Group Commercial |
$90.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.02
|
| Rate for Payer: Multiplan Commercial |
$120.08
|
| Rate for Payer: Networks By Design Commercial |
$97.56
|
| Rate for Payer: Prime Health Services Commercial |
$127.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.05
|
| Rate for Payer: United Healthcare All Other HMO |
$75.05
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.58
|
| Rate for Payer: Vantage Medical Group Senior |
$127.58
|
|
|
VORINOSTAT ORAL SUSPENSION COMPOUND 50 MG/ML [4080357]
|
Facility
OP
|
$49.35
|
|
|
Service Code
|
NDC 9994-0803-57
|
| Hospital Charge Code |
1715205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.40
|
| Rate for Payer: BCBS Transplant Transplant |
$29.61
|
| Rate for Payer: Blue Shield of California Commercial |
$36.37
|
| Rate for Payer: Blue Shield of California EPN |
$28.82
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Cigna of CA HMO |
$34.54
|
| Rate for Payer: Cigna of CA PPO |
$34.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.95
|
| Rate for Payer: Dignity Health Media |
$41.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.74
|
| Rate for Payer: Galaxy Health WC |
$41.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.61
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.84
|
| Rate for Payer: Multiplan Commercial |
$39.48
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$41.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.68
|
| Rate for Payer: United Healthcare All Other HMO |
$24.68
|
| Rate for Payer: United Healthcare HMO Rider |
$24.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.95
|
|
|
VORINOSTAT ORAL SUSPENSION COMPOUND 50 MG/ML [4080357]
|
Facility
IP
|
$49.35
|
|
|
Service Code
|
NDC 9994-0803-57
|
| Hospital Charge Code |
1715205
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: Blue Shield of California Commercial |
$35.14
|
| Rate for Payer: Blue Shield of California EPN |
$25.27
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Cigna of CA HMO |
$34.54
|
| Rate for Payer: Cigna of CA PPO |
$34.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.74
|
| Rate for Payer: Galaxy Health WC |
$41.95
|
| Rate for Payer: Global Benefits Group Commercial |
$29.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.84
|
| Rate for Payer: Multiplan Commercial |
$39.48
|
| Rate for Payer: Networks By Design Commercial |
$32.08
|
| Rate for Payer: Prime Health Services Commercial |
$41.95
|
|
|
VOXELOTOR 500 MG TABLET [226660]
|
Facility
OP
|
$152.38
|
|
|
Service Code
|
NDC 72786-101-01
|
| Hospital Charge Code |
ERX226660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$129.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$129.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$83.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.79
|
| Rate for Payer: BCBS Transplant Transplant |
$91.43
|
| Rate for Payer: Blue Shield of California Commercial |
$112.30
|
| Rate for Payer: Blue Shield of California EPN |
$88.99
|
| Rate for Payer: Cash Price |
$68.57
|
| Rate for Payer: Cash Price |
$68.57
|
| Rate for Payer: Cigna of CA HMO |
$106.67
|
| Rate for Payer: Cigna of CA PPO |
$106.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.52
|
| Rate for Payer: Dignity Health Media |
$129.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.95
|
| Rate for Payer: Galaxy Health WC |
$129.52
|
| Rate for Payer: Global Benefits Group Commercial |
$91.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$114.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.57
|
| Rate for Payer: Multiplan Commercial |
$121.90
|
| Rate for Payer: Networks By Design Commercial |
$76.19
|
| Rate for Payer: Prime Health Services Commercial |
$129.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.19
|
| Rate for Payer: United Healthcare All Other HMO |
$76.19
|
| Rate for Payer: United Healthcare HMO Rider |
$76.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.52
|
| Rate for Payer: Vantage Medical Group Senior |
$129.52
|
|
|
VOXELOTOR 500 MG TABLET [226660]
|
Facility
IP
|
$152.38
|
|
|
Service Code
|
NDC 72786-101-01
|
| Hospital Charge Code |
ERX226660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$129.52 |
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$78.02
|
| Rate for Payer: Cash Price |
$68.57
|
| Rate for Payer: Cigna of CA HMO |
$106.67
|
| Rate for Payer: Cigna of CA PPO |
$106.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.95
|
| Rate for Payer: Galaxy Health WC |
$129.52
|
| Rate for Payer: Global Benefits Group Commercial |
$91.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.57
|
| Rate for Payer: Multiplan Commercial |
$121.90
|
| Rate for Payer: Networks By Design Commercial |
$76.19
|
| Rate for Payer: Prime Health Services Commercial |
$129.52
|
|
|
WARFARIN 0.5 MG PARTIAL TABLET [4081492]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 9994-0814-92
|
| Hospital Charge Code |
NDC4081492
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
WARFARIN 0.5 MG PARTIAL TABLET [4081492]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 9994-0814-92
|
| Hospital Charge Code |
NDC4081492
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 0093-1720-01
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
OP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-89
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Media |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
OP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-01
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.62
|
| Rate for Payer: Dignity Health Media |
$0.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO |
$0.37
|
| Rate for Payer: United Healthcare HMO Rider |
$0.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.62
|
| Rate for Payer: Vantage Medical Group Senior |
$0.62
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
IP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-01
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 0093-1720-01
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
WARFARIN 10 MG TABLET [8748]
|
Facility
IP
|
$0.73
|
|
|
Service Code
|
NDC 0832-1219-89
|
| Hospital Charge Code |
1710799
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.51
|
| Rate for Payer: Cigna of CA PPO |
$0.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.62
|
| Rate for Payer: Global Benefits Group Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.62
|
|
|
WARFARIN 1.25 MG PARTIAL TABLET [4081918]
|
Facility
OP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0819-18
|
| Hospital Charge Code |
ERX4081918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: BCBS Transplant Transplant |
$0.80
|
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.78
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.13
|
| Rate for Payer: Dignity Health Media |
$1.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.67
|
| Rate for Payer: United Healthcare All Other HMO |
$0.67
|
| Rate for Payer: United Healthcare HMO Rider |
$0.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Vantage Medical Group Senior |
$1.13
|
|
|
WARFARIN 1.25 MG PARTIAL TABLET [4081918]
|
Facility
IP
|
$1.33
|
|
|
Service Code
|
NDC 9994-0819-18
|
| Hospital Charge Code |
ERX4081918
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Blue Shield of California Commercial |
$0.95
|
| Rate for Payer: Blue Shield of California EPN |
$0.68
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna of CA HMO |
$0.93
|
| Rate for Payer: Cigna of CA PPO |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.53
|
| Rate for Payer: Galaxy Health WC |
$1.13
|
| Rate for Payer: Global Benefits Group Commercial |
$0.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.06
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.13
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 0093-1712-01
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
OP
|
$0.44
|
|
|
Service Code
|
NDC 0832-1211-89
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: BCBS Transplant Transplant |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
| Rate for Payer: Dignity Health Media |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
| Rate for Payer: United Healthcare All Other HMO |
$0.22
|
| Rate for Payer: United Healthcare HMO Rider |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
IP
|
$0.19
|
|
|
Service Code
|
NDC 57237-119-01
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
OP
|
$0.45
|
|
|
Service Code
|
NDC 0832-1211-01
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.38
|
| 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 |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.20
|
| 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 |
$0.38
|
| Rate for Payer: Dignity Health Media |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| 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 |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
IP
|
$0.45
|
|
|
Service Code
|
NDC 0832-1211-01
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| 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 |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.36
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
IP
|
$0.44
|
|
|
Service Code
|
NDC 0832-1211-89
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.37
|
| Rate for Payer: Global Benefits Group Commercial |
$0.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
|
WARFARIN 1 MG TABLET [11664]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
NDC 57237-119-01
|
| Hospital Charge Code |
1711483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: BCBS Transplant Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Media |
$0.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.08
|
| Rate for Payer: Galaxy Health WC |
$0.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
|
